Diabetes Care, Vol 17, Issue 9 1064-1066, Copyright © 1994 by American Diabetes Association

ARTICLES

Complications of the pump pocket may represent a significant cause of incidents with implanted systems for intraperitoneal insulin delivery

E Renard, J Bringer, D Jacques-Apostol, D Lauton, C Mestre, G Costalat and C Jaffiol
Department of Endocrinology, Lapeyronie Hospital, Montpellier, France.

OBJECTIVE--To increase awareness of adverse events associated with the use of programmable implantable pumps (PIPs). CASES--There were 7 cases of complications associated with the pump-pocket among 40 patients treated by PIP, and we searched for risk factors. RESULTS--Seven of 40 type I diabetic patients treated by PIP presented severe complications of the pump-pocket, resulting in five definitive explanations and nine other surgical interventions. The lesions included an exudative reaction in the pump-pocket and a skin retraction or atrophy, which were complicated by skin erosion in five patients. Coagulase-negative staphylococcus was identified in the pump-pocket in four patients, including three cases of skin erosion. No specific risk of local complications could be attributed to age, sex, duration of diabetes, body mass index, presence of retinopathy or peripheral neuropathy, HbA1c level since implantation, depth of implantation in the abdominal wall, or duration of experience with PIP. Usual physical activity corresponding to > 2,000 kcal energy expenditure per week, estimated by a questionnaire, appeared to be the only identified significant risk factor. CONCLUSIONS--From these results, we suggest that physical activity should be limited to moderate exercise and exclude vigorous efforts in diabetic patients treated by PIP to avoid an increased risk of complications at the implantation site.
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