Original Article
Copyright ©2012 Baishideng. All rights reserved.
World J Diabetes. Aug 15, 2012; 3(8): 142-148
Published online Aug 15, 2012. doi: 10.4239/wjd.v3.i8.142
Complications of continuous intraperitoneal insulin infusion with an implantable pump
Peter R van Dijk, Susan JJ Logtenberg, Klaas H Groenier, Jan Willem Haveman, Nanno Kleefstra, Henk JG Bilo
Peter R van Dijk, Susan JJ Logtenberg, Klaas H Groenier, Nanno Kleefstra, Henk JG Bilo, Diabetes Centre, Isala Clinics, Dokter van Heesweg 2, 8000 GK Zwolle, The Netherlands
Susan JJ Logtenberg, Nanno Kleefstra, Henk JG Bilo, Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
Klaas H Groenier, Department of General Practice, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
Jan Willem Haveman, Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
Nanno Kleefstra, Langerhans Medical Research Group, Dokter van Heesweg 2, 8025 BT Zwolle, The Netherlands
Henk JG Bilo, Isala Clinics, Department of Internal Medicine, Dokter Spanjaardweg 12, 8025 AB Zwolle, The Netherlands
Author contributions: van Dijk PR, Logtenberg SJJ, Haveman JW, Kleefstra N and Bilo HJG designed the research; van Dijk PR, Logtenberg SJJ and Haveman JW performed the research; Groenier KH contributed to statistical analysis; van Dijk PR, Logtenberg SJJ, Haveman JW, Kleefstra N and Bilo HJG wrote the paper.
Correspondence to: Peter R van Dijk, MD, Diabetes Center, Isala clinics, PO Box 10400, 8000 GK Zwolle, The Netherlands. p.r.van.dijk@isala.nl
Telephone: +31-38-4247942 Fax: +31-38-4247695
Received: May 23, 2012
Revised: July 30, 2012
Accepted: August 8, 2012
Published online: August 15, 2012
Abstract

AIM: To monitor the course of continuous intraperitoneal insulin infusion (CIPII) and to gain more insight into possible complications.

METHODS: A retrospective, longitudinal observational cohort study in patients with type 1 diabetes mellitus (T1DM) was performed. Only patients with “brittle” T1DM who started CIPII between January 1, 2000 and June 1, 2011, and were treated in the only centre in The Netherlands providing CIPII treatment (Isala clinics, Zwolle) were eligible for inclusion. Outcomes were defined as operation-free period (OFP), rate and type of complications. Subanalyses were made between patients starting CIPII from 2000 to 2007 and from 2007 onwards in order to study possible changes over time in complications and/or OFP. The OFP was calculated as the time from initial implantation to the date of first documented re-operation. If patients had not experienced an operation, their data were recorded at the date of last follow up or death. Kaplan-Meier curves were constructed to visualize the OFP. A (two-sided) P value of less than 0.05 was considered statistically significant.

RESULTS: Fifty-seven patients were treated with CIPII, although one patient was excluded from analyses because of self-induced complications. In the remaining 56 patients, 70 complications occurred during 283 patient years. Catheter occlusion (32.9%), pump dysfunction (17.1%), pain at the pump site (15.7%) and infections (10.0%) were the most frequent complications. This resulted in a median OFP of 4.5 years (95% confidence interval 4.1-4.8 years) without any difference between the time periods. Fifty re-operations were performed because of complications, one per 5.6 patient years, with a decrease in pump dysfunction (P = 0.04) and pump explantations (P = 0.02) after 2007. In total, 9 episodes of ketoacidosis occurred during follow up and there were 69 hospital re-admissions, with a median duration of 6 d. CIPII was ceased in five patients due to recurrent infections (n = 2), pain (n = 1), inadequate glycaemic control (n = 1) or by own choice (n = 1). No CIPII related mortality was reported.

CONCLUSION: The OFP has been stable over the last decade. No CIPII related mortality was reported. A significant decrease in pump dysfunction and explantation was seen after 2007 compared to the period 2000-2007. CIPII remains a safe treatment modality for specific patient groups.

Keywords: Diabetes mellitus type 1, Intraperitoneal insulin infusion, Insulin infusion systems, Complications, Surgery