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Finding the right route for insulin delivery - an overview of implantable pump therapy.

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Bally, Lia 
Thabit, Hood 


Implantable pump therapy adopting the intraperitoneal route of insulin delivery has been available for the past three decades. The key rationale for implantable pump therapy is the restoration of the portal-peripheral insulin gradient of the normal physiology. Uptake in clinical practice is limited to specialized centers and selected patient populations. Areas covered: Implantable pump therapy is discussed, including technical aspects, rationale for its use, and glycemic and non-glycemic effects. Target populations, summaries of clinical studies and issues related to implantable pump therapy are highlighted. Limitations of implantable pump therapy and its future outlook in clinical practice are presented. Expert opinion: Although intraperitoneal insulin delivery appears closer to the normal physiology, technical, pharmacological, and costs barriers prevent a wider adoption. Evidence from clinical studies remains scarce and inconclusive. As a consequence, the use of implantable pump therapy will be confined to a small population unless considerable technological progress is made and well-conducted studies can demonstrate glycemic and/or non-glycemic benefits justifying wider application.



Type 1 diabetes, diabetes technology, implantable pump, intraperitoneal insulin delivery, Animals, Blood Glucose, Diabetes Mellitus, Type 1, Humans, Hypoglycemic Agents, Infusion Pumps, Implantable, Insulin, Insulin Infusion Systems, Pancreas, Artificial

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Expert Opin Drug Deliv

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Informa UK Limited
National Institute of Diabetes and Digestive and Kidney Diseases (UC4DK108520)
Diabetes UK (14/0004878)
Juvenile Diabetes Research Foundation Ltd (JDRF) (2-SRA-2014-256-M-R)
NIHR Evaluation Trials and Studies Coordinating Centre (14/23/09)
Supported by National Institute of Health Research Cambridge Biomedical Research Centre, Efficacy and Mechanism Evaluation National Institute for Health Research (#14/23/09), The Leona M. & Harry B. Helmsley Charitable Trust (#2016PG-T1D045), JDRF (#2-SRA-2014-256-M-R), National Institute of Diabetes and Digestive and Kidney Diseases (1UC4DK108520-01), and Diabetes UK (#14/0004878). LB receives support from the Swiss National Science Foundation (P1BEP3_165297).