Résumé
Continuous intraperitoneal insulin infusion (CIPII) presents specific pharmacokinetics and pharmacodynamics which allow insulin replacement in a way closer to physiology than subcutaneous insulin delivery. Insulin absorption occurs faster, mainly in the hepatic venous portal system, which results in lower peripheral insulin levels. Insulin action on glucose levels is quicker, more reproducible, and shorter, which allows a more accurate and reactive tuning. CIPII was initially used in patients with brittle diabetes, via the percutaneous implantation of abdominal catheters to which portable pumps were connected. The development of fully implantable, programmable insulin pumps followed the availability of concentrated insulin preparations which were stable for weeks at body temperature. Clinical studies have documented the improved stability of blood glucose levels under CIPII, resulting in sustained near-normoglycemia combined with a dramatic reduction of hypoglycemic excursions in patients who were poorly controlled with subcutaneous insulin infusion. Episodes of underdelivery still affect CIPII from implanted pumps. Pump slowdowns occur periodically due to gradual depots of aggregated insulin in the pumping mechanism. Although fully reversible by NaOH rinsing of the pump insulin pathways, these recurrent reductions of insulin delivery remain a limitation of this technology. Recent trials have shown interest in CIPII in artificial pancreas models.