Continuous Ambulatory Peritoneal Dialysis in Diabetes mellitus

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Abstract
Insulin-dependent diabetic patients (14) completed 122 patient months on continuous ambulatory peritoneal dialysis (CAPD), using only i.p. insulin for glucose control. Survival was 70% at 1 yr, in this relatively high-risk group, several members of which were refused other modalities of treatment. Blood glucose control, using .apprx. 111 units of regular insulin/day i.p., was improved over pre-CAPD control, as assessed by monthly blood glucose determinations and HbA1c measurements. Pre-CAPD random blood glucose values fell in 13 of 14 from a mean of 367 .+-. 42 to 207 .+-. 15 mg/dl during CAPD. Mean pre-CAPD Hb A1c levels were 14.2% with a fall to 10.5-11.4% during CAPD. The i.p. insulin dose represented .apprx. 3.5 times the pre-CAPD total daily s.c. dose of insulin, and no patient required less than approximately twice the pre-CAPD insulin dose. Peritonitis rates were no different when compared to the general nondiabetic population on CAPD (269 patient mo.), and complicated episodes tended to be less frequent in diabetic patients. I.p. insulin administration is an effective means of controlling blood sugar in diabetics on CAPD, and does not increase the risk of infection.

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