What does this research mean for the field?

Long-term continuous insulin infusion via portable pumps significantly improves blood glucose and HbA1 compared to conventional therapy in brittle diabetes, with the intraperitoneal route providing superior long-term catheter tolerance over subcutaneous and intravenous administration. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 1, 1983Diabetes Care

Long-Term Ambulatory Peritoneal Insulin Infusion of Brittle Diabetes with Portable Pumps: Comparison with Intravenous and Subcutaneous Routes

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Brittle Diabetes (n=6). Intervention: Constant insulin infusion via portable pumps vs. Conventional therapy. Primary outcome: Mean blood glucose (mg/dl).

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Key result

Portable insulin pumps reduce mean blood glucose ~47% vs conventional therapy in unstable diabetes.

Why the study?

The long-term feasibility and comparative effectiveness of insulin infusion via portable pumps through subcutaneous, intravenous, and intraperitoneal routes in severely unstable diabetic individuals were unclear.

Does intraperitoneal insulin infusion via portable pumps improve diabetic control and long-term feasibility compared to subcutaneous or intravenous routes in severely unstable diabetic individuals?

Comparison

Subcutaneous vs intravenous vs intraperitoneal insulin infusion via portable pumps

Design

Randomized trial with three 1-month infusion periods per patient

Follow-up

10-18 months

Authors

JSJ. L. SélamCentre Hospitalier Universitaire de Nîmes ASA SlingeneyerAgence de la Biomédecine BHB. HédonHôpital Pellegrin

Discussion

Member takes

Implication

May support implanted catheter pumps in select unstable diabetes; leaves open randomized confirmation of safety and efficacy.

Study Design

Type

RCT (n=6)

Randomization

randomized

Structured PICO

Does intraperitoneal insulin infusion via portable pumps improve diabetic control and long-term feasibility compared to subcutaneous or intravenous routes in severely unstable diabetic individuals?

Population

6 severely unstable diabetic individuals underwent randomized 1-month periods of subcutaneous, intravenous, and intraperitoneal insulin infusion, followed by 10-18 months of constant infusion.

Intervention

Insulin infusion via portable pumps (Promedos pumps) with chronically implanted catheters. Patients underwent three randomized 1-month periods of subcutaneous (s.c.), intravenous (i.v.), and intraperitoneal (i.p.) infusion, followed by indefinite placement in one site.

Comparator

Conventional therapy (baseline) and comparison between the three infusion routes (s.c., i.v., i.p.).

Outcome

Diabetic control (mean blood glucose and HbA1) and long-term feasibility/complications.surrogate

Main Result

Absolute Event Rate: 126% vs 237%

Intraperitoneal insulin infusion via portable pumps provides sustained improvement in glycemic control for brittle diabetes and appears more feasible long-term than subcutaneous or intravenous routes due to fewer catheter complications.

Limitations

Subcutaneous catheters provoked local reactions after less than 1 month
Chronic intravenous catheters obstructed after 8 and 9 months
Intensive education and careful follow-up are necessary

Cite This Study

Sélam et al. (1983) conducted an RCT in Brittle Diabetes (n=6). Constant insulin infusion via portable pumps vs. Conventional therapy was evaluated on Mean blood glucose (mg/dl). Long-term constant insulin infusion via portable pumps improved mean blood glucose (126 vs 237 mg/dl) and HbA1 (8.3% vs 10.0%) compared to conventional therapy in unstable diabetic individuals.

synapsesocial.com/papers/6aacfa7dcf00d6f7953fe583 https://doi.org/10.2337/diacare.6.2.105

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Long-Term Ambulatory Peritoneal Insulin Infusion of Brittle Diabetes with Portable Pumps: Comparison with Intravenous and Subcutaneous Routes

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Long-Term Ambulatory Peritoneal Insulin Infusion of Brittle Diabetes with Portable Pumps: Comparison with Intravenous and Subcutaneous Routes

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider