Clinical experience in human diabetics with portable and implantable insulin minipumps.

We report our personal experience of chronic ambulatory insulin therapy via portable and implantable pumps in insulin-dependent diabetics. Fifteen patients, poorly controlled on conventional insulin injections, were equipped with portable Siemens pumps. These pumps offer compactness, safety means, portability, one-month insulin reservoir and variable insulin rates. The pump catheter was chronically inserted in the peritoneal space using a non-surgical personal technique. Our present experience, representing six patient-years of treatment (range 1 to 16 months), shows excellent steady blood glucose control (mean blood glucose is 115 +/- 5 mg/dl v. 187 +/- 21 mg/dl with conventional therapy). All incidents were minor and most were catheter related. However, there was no catheter removal or discontinuation of pump treatment. All patients declared that there was a marked improvement in their quality of life. One of the pump-treated patients agreed to be transferred to a totally implantable Siemens prototype. The pump was inserted in the muscular wall of abdomen, and the delivery catheter terminated in the peritoneal space. Refills are made percutaneously approximately every 20 days. Rates and functions of the pump are remotely controlled. Five months after implantation, results, compared with those of a portable pump, show similar excellent blood glucose control and pump precision with a further improvement in the patient's quality of life. Thus, although further miniaturization and longer autonomy are expected in the forthcoming devices, our present experience shows that, with careful patient instruction and follow up, insulin pumps could represent in the next years an alternative to conventional insulin therapy for poorly controlled diabetics.