French multicentre experience of implantable insulin pumps. The EVADIAC Study Group. Evaluation of Active Implants in Diabetes Society.

Limitations of intensive diabetes treatment with subcutaneous insulin include achievement of only near-normoglycaemia and increased risk of hypoglycaemia. Programmable implantable pumps permit variable rates of intraperitoneal insulin infusion. The French experience represents 224 type I adult diabetic patients followed up for 353 patient-years in seven centres. Compared with pre-implantation values with intensive subcutaneous insulin, glycaemic control was significantly improved with implantable pumps: glycosylated haemoglobin fell from 7.4 (1.8)% to 6.8 (1.0)% at 6 months (mean, SD, p < 0.001). The incidence of severe episodes of hypoglycaemia decreased from 15.2 to 2.5 per 100 patient-years (p < 0.001). Intraperitoneal insulin delivery with implantable pumps improved the risk-benefit ratio of intensive insulin.