Continuous intraperitoneal insulin infusion in the treatment of type 1 diabetes mellitus: Glycaemia and beyond

Continuous intraperitoneal insulin infusion (CIPII) with an implantable pump is a last-resort treatment option for selected patients with type 1 diabetes mellitus (T1DM). As compared to the most commonly used forms of insulin administration -injections and an externally placed pump- which deliver insulin in the subcutaneous (SC) tissue, CIPII delivers the insulin in the intraperitoneal space. CIPII using an implantable pump is an unique treatment which has been available for more than 30 years and is nowadays used in very few patients around the world. In The Netherlands, the Isala hospital in Zwolle is the only center providing this treatment. Aim of this thesis was to provide an update and extension about the knowledge of CIPII in the management of T1DM by investigating several important and relative new aspects of this treatment modality. It was demonstrated that CIPII is a safe and effective therapy for selected patients with T1DM. The predominant effect of CIPII, also as compared to SC insulin therapy administration, is a reduction of the number of hypoglycaemic (low blood glucose concentrations) episodes. Furthermore, treatment satisfaction is high among patients treated with CIPII using an implantable pump. Finally, this thesis demonstrated that the effects of CIPII reach beyond glycaemia by demonstrating restoration of the altered ‘growth-hormone – insulin-like growth factor 1 axis’ with CIPII