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Continuous intraperitoneal insulin infusion in the treatment of type 1 diabetes mellitus

Glycaemia and beyond
PhD ceremony:dr. P.R. van Dijk
When:January 21, 2015
Supervisors:prof. dr. H.J.G. (Henk) Bilo, prof. dr. R.O.B. (Reinold) Gans
Co-supervisors:dr. N. (Nanno) Kleefstra, S.J.J. Logtenberg
Where:Academy building RUG
Faculty:Medical Sciences / UMCG
Continuous intraperitoneal insulin infusion in the treatment of
type 1 diabetes mellitus

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 a 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 kind of treatment. Aim of this thesis was to provide an update and extension of 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, in this thesis we demonstrate that the effects of CIPII reach beyond glycaemia by showing restoration of the altered ‘growth-hormone – insulin-like growth factor 1 axis’ with CIPII.