Factors Involved in Catheter Obstruction During Long-Term Peritoneal Insulin Infusion
- Regine Bousquet-Rouaud, MD,
- Françoise Castex, DSC,
- Guy Costalat, MD,
- Madeleine Bastide, DSC,
- Bernard Hedon, MD,
- Majida Bouanani, DSC,
- Sylvie Jouvert, BS and
- Jacques Mirouze, MD
- Department of Metabolic and Endocrine Diseases, the Department of Immunology, Faculte of Pharmacy, and the Department of Obstetrics and Gynecology, Lapeyronie University Hospital Montpellier, France
- Address correspondence and reprint requests to Regine Bousquet-Rouaud, MD, Department of Endocrine Diseases, Lapeyronie University Hospital, 555 Route De Ganges, 34059 Montpellier, France.
Abstract
OBJECTIVE To analyze the efficacy of ECPII and the factors responsible for technical problems often encountered. This treatment has been in use with IDDM patients since 1980.
RESEARCH DESIGN AND METHODS Forty-four IDDM treated by ECPII for 42–78 mo (mean, 53 mo). patients were
RESULTS Glycemic equilibrium was improved during treatment (mean plasma glucose level, 7.6 mM; mean GHb level, 8%). Catheter blockage was the main reason for ECPII failure (74%). Mean catheter survival of each catheter, determined by actuarial analysis, was 11.7 mo and significantly decreased with subsequent implantation. SEM of the catheter tips showed deposits composed of fibrin and cells occluding the inner lumen. Factors such as age, sex, local infection, and low insulin basal rate were not found to have any incidence on the catheter survival. Placement of the catheter in the upper part of the peritoneum, however, increased catheter survival. Anti-insulin antibodies did not seem to be directly involved in blockage.
CONCLUSIONS We conclude from this long-term experience that during ECPII, catheter blockage remains the major recurring complication, probably involving a local immune-inflammatory response in the peritoneum.
- Received July 10, 1991.
- Revision received April 16, 1992.
- Accepted April 16, 1992.
- Copyright © 1993 by the American Diabetes Association
