Implanted programmable insulin pumps: one hundred fifty-three patient years of surgical experience

Surgery
R UdelsmanC D Saudek

Abstract

Implanted insulin pumps (IIPs) are an alternative treatment for diabetes mellitus. To maintain good glycemic control, patients with an IIP require frequent surgical interventions. Since November 1986, 21 patients with insulin-dependent diabetes mellitus at the Johns Hopkins Hospital have undergone implantation of pumps subcutaneously with a catheter delivering insulin into the peritoneal space. Patients were followed up with self-monitoring of blood glucose levels two to four times daily and percutaneous refills of the pump with U-400 insulin every 6 to 12 weeks. In 153 patient-years, 77 pumps were placed. The mean pump life was 29 +/- 2 months. Morbidity was limited to pump site infections (3.9%) and one small bowel obstruction. Inadvertent insulin overdelivery has never occurred. Episodes of insulin underdelivery were caused by backflow anomalies (n = 67), which were cleared by percutaneous rinses, or catheter obstructions (n = 12), which required catheter replacements. Ninety-one operations were required to maintain pump function. All patients are alive and report improvements in quality of life. Significant reductions in hemoglobin A1C and plasma glucose levels were also seen. Long-term use of IIPs results in significant im...Continue Reading

Citations

Dec 3, 2008·Langenbeck's Archives of Surgery·Jan Willem HavemanAdri M Blomme
Mar 3, 1998·Journal of the American College of Surgeons·J A van Heerden
Aug 23, 2012·World Journal of Diabetes·Peter R van DijkHenk Jg Bilo
Jun 7, 2006·Minimally Invasive Therapy & Allied Technologies : MITAT : Official Journal of the Society for Minimally Invasive Therapy· Renard
Nov 4, 2009·Journal of Diabetes Science and Technology·Carl Edman, Darrel Drinan

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