Catheter Survival During Long-Term Insulin Therapy With an Implanted Programmable Pump

Abstract

Nonsurgical management of catheter occlusions contributed to extend catheter lifetime. Intraperitoneal catheters have a lower morbidity and a higher survival than intravenous catheters.

Human insulin production and amelioration of diabetes in mice by electrotransfer-enhanced plasmid DNA gene transfer to the skeletal muscle

“…4 However, problems related to management, acceptability and costs further reduce the use of this kind of treatment. [5][6][7] Correspondence: S Martinenghi, Alternative therapeutic approaches based on allogenic transplantation are indeed a clinical option, but only in selected cases. Pancreas transplantation is able to completely normalize glucose metabolism, but is a major surgical procedure and requires permanent immunosuppression, 8 which is associated with increased risk of cancer 9 and infections.…”

Implantable insulin delivery pumps

“…Identi®ed factors in association with catheter obstructions include: previous experience with IP insulin delivery using transparietal catheters connected to external pumps, diabetes duration >21 years and infusion of physicallyunstable insulin batches [35,36]. Two kinds of obstructions have been described by all teams: distal occlusion of the catheter by ®brinous material and catheter encapsulation due to the formation of ®brous and in¯ammatory tissue more or less extended along the catheter [19,20,34,36]. Phenomena exposing to encapsulation remain poorly understood.…”

“…The incidence of catheter obstructions has been reported from 7.8 to 57.3 per 100 patient-years [17,19,20,23,25,34,35]. Identi®ed factors in association with catheter obstructions include: previous experience with IP insulin delivery using transparietal catheters connected to external pumps, diabetes duration >21 years and infusion of physicallyunstable insulin batches [35,36].…”

Dosage Form Development, in Vitro Release Kinetics, and in Vitro–in Vivo Correlation for Leuprolide Released from an Implantable Multi-reservoir Array

“…Implantable pumps have been developed to deliver drugs in either a pulsatile or continuous manner. However, these devices are relatively large (3), are susceptible to clogging (4,5), and are limited to delivering solution phase drug formulations. The preferred drug delivery implant will be small in size, protect the drug from physiological fluids that can accelerate drug decomposition, control release kinetics and dose, and be controllable by physician or patient.…”