A second-generation intraperitoneal insulin pump — the next-generation MiniMed Implantable Insulin Pump System (MIIPS 2020),  which is not yet commercially licensed but can be obtained in some cases on compassionate-use grounds — may be an option for select patients with type 1 diabetes (T1D) for whom subcutaneous insulin delivery isn’t possible. 

“It’s important for clinicians to understand how intraperitoneal insulin fits into the clinical pathway for people with T1D and know how to refer to specialist centers for review,” said Nick Oliver, MD, the Wynn Professor of Metabolism, Imperial College London, who presented background about the device at the 19th International Conference on Advanced Technologies and Treatments for Diabetes (ATTD) 2026. 

“One of the major challenges is enabling people with T1D who potentially meet the criteria to access the technology,” he told Medscape Medical News. 

“Greater awareness of intraperitoneal insulin has the potential to greatly help people with challenging skin conditions, and people experiencing recurrent, severe hypoglycemia despite optimized subcutaneous insulin with multidisciplinary education and support,” he explained.

An international position statement, due to be published later in 2026, will provide guidance on use of the MIIPS 2020. The implanted device delivers insulin into the peritoneum, enabling direct absorption by the liver and bypassing systemic challenges experienced by a small population with T1D. It lasts about 7 years, similar to a pacemaker, and holds 20 mL of U100 insulin (2000 units) or 8000 units of Insuman U400 insulin. Reservoir refills are required about every 3-4 months, through a port on the skin’s surface.

According to Oliver, the upcoming position is expected to recommend use of the MIIPS 2020 as an option for the following people with T1D: 

• Those on optimized intensive insulin therapy for whom subcutaneous insulin is unsuitable due to congenital or acquired lipodystrophy, lipoatrophy, or lipohypertrophy; cutaneous allergy to insulin preparations or its delivery materials; subcutaneous insulin resistance; or coexisting skin conditions that prevent subcutaneous insulin use.
• Those with recurrent or unexplained severe hypoglycemia or hyperglycemia despite maximal therapeutic optimization who don’t want or can’t receive islet or pancreas transplantation.

Intraperitoneal insulin therapy should be provided in a multidisciplinary specialist center, according to the statement. 

Current challenges of the technology include requirements for operative implantation, reservoir refills in specialist centers, and cost. The 2020 device has a lower risk for catheter occlusion, a possible complication of intraperitoneal insulin pumps, compared to the previous (2007) version, and is smaller, Oliver noted. The occlusion rate is now about 8 per 100 patient-years, and can often be resolved by flushing the system through without having to remove the pump, he said. 

Niche Product

Asked to comment, ATTD meeting co-chair Tadej Battelino, MD, head of the Department of Endocrinology at UCH-UMC Ljubljana, and chair and professor of pediatrics at the University of Ljubljana, Slovenia, said, “I think this is really for extreme cases where they can't use external pumps.”

“It's obviously very good to have it, and I'm sure there is a group of people that can benefit, but it's a niche product,” he told Medscape Medical News.

MiniMed is conducting a premarket, interventional, prospective, open-label, multicenter trial of the MIIPS 2020 in 40 adults with T1D. Results are expected in 2027. Previous versions of the device have been used primarily in France for over 40 years, and some patients still have older devices implanted. Fewer than 200 patients worldwide currently have one. 

The system is currently open-loop, meaning that it doesn’t interact with a continuous glucose monitor, but “with the potential for closed-loop in the future,” a MiniMed representative told Medscape Medical News. 

Oliver has received consultation and/or lecture fees from Eli Lilly & Co, Dexcom, MiniMed, Roche Diabetes, AstraZeneca, Sanofi, and Tandem, and research support from Dexcom, MiniMed, and Roche Diabetes. Battelino has received research grants (paid to his institution) from Abbott, Medtronic, NovoNordisk, Sanofi, Novartis, Sandoz, and Zealand Pharma. 

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in The Washington Post, NPR’s Shots blog, and Diatribe. She is on X (formerly Twitter) @MiriamETucker and BlueSky @miriametucker.bsky.social