Summary
The development of implantable, remotecontrolled insulin pumps dates back to the early 1970's when it was recognized that conventional insulin therapy may be inadequate to control microvascular complications. For the first prototypes the intraperitoneal access route was favoured because of a physiological portal/peripheral insulin gradient. With intraperitoneal insulin delivery excellent metabolic control can be obtained with glycohaemoglobin values close to the upper normal range. Although long-term studies in insulin-dependent diabetic patients show comparable results with respect to glycaemic control and intermediary substrate levels with intensive conventional therapy, the advantage of intraperitoneal insulin delivery may lie in the low rate of hypoglycaemic episodes.
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Hanssen KF, Bangstad HJ, Brinchmann-Hansen D, DahlJörgensen K (1992) Blood glucose control and diabetic microvascular complications: long-term effects of near-normoglycemia. Diabetic Med 9: 697–705
The Diabetes Control and Complications Trial (DCCT) (1993) N Engl J Med 329: 683–689
Bessmann SP, Schultz RD (1972) Sugar electrode sensor for the ‘artificial pancreas’. Horm Metab Res 4: 413–417
Hepp KD, Renner R, von Funcke HJ, Mehnert H, Haerten R, Kresse H (1975) Intravenous insulin therapy under conditions imitating physiological profiles. Diabetologia 11: 349 (Abstract)
Hepp KD, Renner R, von Funcke HJ, Mehnert H, Haerten R, Kresse H (1977) Glucose homeostasis under continuous intravenous insulin therapy in diabetics. In: Kruse-Jarres D, Molnar GD (eds) Blood glucose monitoring. Methodology and clinical application of continuous in vivo glucose analysis. Horm Metab Res 7 [Suppl ]: 72–76
Renner R, Hepp KD, Mehnert H, Franetzki M, Kresse H (1977) Continuous insulin therapy with a portable miniaturized infusion system. Diabetologia 13: 427 (Abstract)
Thurow H, Geisen K (1984) Stabilization of dissolved proteins against denaturation at hydrophobic interfaces. Diabetologia 27: 212–218
Pickup J, Keen H, Parsons J, Alberti KGMM (1978) Continuous subcutaneous insulin infusion: an approach to achieving normoglycaemia. BMJ 1: 201–207
Schade DS, Eaton RP, Friedman N, Spencer WJ (1979) The intravenous, intraperitoneal and subcutaneous routes of insulin delivery in diabetic man. Diabetes 28: 1069–1072
Irsigler K, Kritz H, Hagmüller G et al. (1981) Long-term continuous intraperitoneal insulin with an implanted remote-controlled insulin infusion device. Diabetes 30: 1072–1075
Schade DS, Eaton RP, Edwards WS et al. (1982) A remotely programmable insulin delivery system: successful shortterm implantation in man. JAMA 247: 1848–1853
Walter H, Kemmler W, Kronski D et al. (1983) Implantation of a program-controlled device with intravenous insulin infusion in a patient with type I diabetes mellitus. In: Brunetti P, Alberti KGMM, Albisser AM, Hepp KD, Massi-Benedetti M (eds) Artificial systems for insulin delivery. Raven Press New York, pp 313–315
Selam JL, Slingeneyer A, Chaptal PA et al. (1983) One year continuous run with the totally implantable Siemens pump in human diabetics. In: Irsigler K, Kritz H, Lovett R (eds) Diabetes treatment with implantable insulin infusion systems. Urban und Schwarzenberg, Munich pp 126–131
Buchwald H, Barbosa J, Varco RL et al. (1981) Treatment of a type II diabetic by a totally implantable insulin infusion device. Lancet 1: 1233–1235
Point Study Group (1988) One-year trial of a remote-controlled implantable insulin infusion system in type I diabetic patients. Lancet 1: 866–869
Schade DS, Duckworth WC (1986) In search of the subcutaneous insulin degradation syndrome. N Engl J Med 315: 147–153
Schade DS, Eaton RP (1980) The peritoneum: a potential insulin delivery route for a mechanical pancreas. Diabetes Care 3: 229–234
Schade DS, Eaton RP, Davis T et al. (1981) The kinetics of peritoneal insulin absorption. Metabolism 30: 149–155
Selam JL, Bergman RN, Raccah D, Jean-Didier N, Lozano J, Charles A (1990) Determination of portal insulin absorption from peritoneum via novel isotopic method. Diabetes 39: 1361–1365
Giacca A, Caumo A, Galimberti J et al. (1993) Peritoneal and subcutaneous absorption of insulin in type I diabetic subjects. J Clin Endocrinol Metab 77: 738–742
Schade DS, Eaton RP, Friedman NM, Spencer WJ (1980) Normalization of plasma insulin profiles with intraperitoneal insulin infusion in diabetic man. Diabetologia 19: 35–39
Duckworth WC, Saudek CD, Henry RR (1992) Why intraperitoneal delivery of insulin with implantable pumps in NIDDM? Diabetes 41: 657–661
Bauersachs R, Piwernetz K, Renner R et al. (1993) Hormone and substrate levels after long-term continuous intraperitoneal insulin infusion in insulin-dependent diabetes mellitus. Diab Nutr Metab 6: 25–32
Piwernetz K, Selam JL, Mirouze J, Renner R, Hepp KD (1988) Hybrid control of peritoneal insulin infusion. Diab Nutr Metab 1: 49–55
Saudek CD, Selam JL, Pitt HA et al. (1989) A preliminary trial of the programmable medication system for insulin delivery. N Engl J Med 321: 574–579
Selam JL, Raccah D, Jean-Didier N, Lozano JL, Waxman K, Charles MA (1992) Randomized comparison of metabolic control achieved by intraperitoneal insulin infusion with implantable pumps versus intensive subcutaneous insulin therapy in type I diabetic patients. Diabetes Care 15: 53–58
Jean-Didier N, Hanaire-Brutin H, Lassmann-Vague et al. (1993) Safety and efficacy of long term intraperitoneal insulin infusion by means of implantable pumps: the EVA-DIAC Survey. Diabetologia 36 [Suppl 1]: A 37 (Abstract)
Selam JL, Kashyap M, Alberti KGMM et al. (1989) Comparison of intraperitoneal and subcutaneous insulin administration of lipids, apolipoproteins, fuel metabolites and hormones in type I diabetes mellitus. Metabolism 38: 908–912
Monti LD, Piatti PM, Home PD, Tomson C, Alberti KGMM (1992) The effect of intraperitoneal insulin delivery on carbohydrate metabolism in type 1 (insulin-dependent) diabetic patients. Diab Res Clin Pract 15: 237–244
Chase HP, Jackson WE, Hoops L, Cockerham RS, Archer PG, O'Brien D (1989) Glucose control and the renal and retinal complications of insulin-dependent diabetes. JAMA 261: 1155–1160
Hirsch IB, Farkar-Hirsch R, Skyler J (1990) Intensive insulin therapy for treatment of type I diabetes. Diabetes Care 13: 1265–1283
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Hepp, K.D. Implantable insulin pumps and metabolic control. Diabetologia 37 (Suppl 2), S108–S111 (1994). https://doi.org/10.1007/BF00400833
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DOI: https://doi.org/10.1007/BF00400833