Insulin pump users would not rule out using an implantable artificial pancreas

The aim of this survey was to establish the limitations of open loop continuous subcutaneous insulin infusion (CSII) as perceived by current users of the technology, and to ascertain their interest in and requirements for a non-electronic implantable closed loop insulin pump, INSmart, currently under development for the treatment of type 1 diabetes. INSmart has been surgically implanted in the peritoneum in animal models and continuously restored normoglycaemia. A bottom-up survey design was used to determine both positive and negative experiences of patients currently using CSII to define the performance characteristics they would require from a non-electronic, implantable closed loop insulin pump. A total of 360 insulin pump users completed the survey. All respondents had type 1 diabetes, were predominantly from English-speaking countries and had been diagnosed before age 34 years. Most had well controlled blood glucose (BG) according to their selfreported HbAic results. They reported a reduction in this value after transferring to CSII from multi-dose injections. However, 70% of pump users had more than three hypoglycaemic episodes per week. Eighty percent reported self-measured BG values > 10mmol/L three or more times per month; 94% of respondents considered a (non-electronic implantable) closed loop insulin pump would make their BG management easier and improve their quality of life. The majority of respondents felt there were still many disadvantages to current external insulin pumps such as their constant visible presence, rotation of insertion sites and skin inflammation. These shortfalls could be overcome by a device, such as INSmart, that provides a relatively instant feedback mechanism for controlling insulin release due to its proposed location in the peritoneal cavity. Copyright (C) 2014 John Wiley & Sons.