Pompes à insuline externes et implantables dans le diabète de type 1 : bénéfices et perspectives

The goal of type 1 diabetes treatment is to obtain a good glycemic control in order to prevent the development of chronic complications, while reducing the frequency of hypoglycemic episodes. This compromise, sometimes difficult to achieve with multiple daily injections, may be more easily obtained with continuous insulin infusion via an external pump. The reliability of pumps and catheters and the kinetics of insulins have considerably improved and external insulin pump treatment is nowadays widely spread in France. However it fails to solve the problems of all the patients: high HbA1c levels, frequent or severe hypoglycemia, inadequate insulin absorption, poor compliance to the wearing of the device. Implantable insulin pumps give an answer to a part of these problems, thanks to the intraperitoneal route of insulin injection, allowing a more physiological insulinisation. Another advantage is the absence of external device, which improves the acceptability of the treatment. In all cases, specific therapeutic education and training are required, as well as a continuous evaluation of the benefit/risk ratio of the insulin pump treatment. The features of the pumps and catheters are continuously improving, patch pumps are in development, and several pumps are now equipped with continuous glucose monitoring devices. These technical advances are particularly important for the development of closed-loop systems.