Zusammenfassung
Diabetestechnologie hat sich in der Diabetestherapie etabliert. Der raschen Weiterentwicklung der technischen Möglichkeiten stehen Fragen zum effizienten Einsatz im klinischen Alltag gegenüber. Nur durch adäquates Training der Patienten können die technischen Optionen optimal genutzt werden. Im Bereich der Blutzuckerselbstmessung gibt es Geräte, die nachweislich eine hohe Messgüte aufweisen, auch dadurch, dass sie präanalytische Fehlerquellen gut kompensieren. Wenn die so erhaltenen Messwerte von den Patienten unmittelbar zur Anpassung ihrer Therapie genutzt werden, führt diese „Investition“ auch zu einem Nutzen für den nichtinsulinbehandelten Patienten. Im gleichen Sinn ist der Einsatz des kontinuierlichen Glukosemonitorings („continuous glucose monitoring“, CGM) dann sinnvoll, wenn die Patienten die Geräte häufig nutzen und wissen, wie die angezeigten Werte z. B. bei der Vermeidung von Hypoglykämien helfen. In der Kombination mit Insulinpumpen kann CGM zu einer Automatisierung der Reaktion bei niedrigen Blutglukosewerten führen, d. h., die Basalrate wird von der Pumpe automatisch für maximal 2 h gestoppt. Die rasche Weiterentwicklung der Informationstechnologie wird dem Bereich Diabetestechnologie vermutlich noch einen erheblichen „push“ geben.
Abstract
Diabetes technology is nowadays well established in diabetes therapy. The rapid development of the technological options is contrasted by questions about the clinical efficacy of the usage in daily life. Adequate training of patients is necessary in order to enable usage of all technical options. Many of the instruments used for self-monitoring of blood glucose levels provide a high measurement quality, especially if they are able to compensate preanalytical errors. If the measurement results are used by patients for an immediate and appropriate adjustment of therapy, the investment in such a measurement can be of benefit also in non-insulin-treated patients. In this sense usage of continuous glucose monitoring (CGM) is also useful if patients use such systems regularly and know how to avoid, for example hypoglycemic events by appropriate reaction to the values displayed. In combination with insulin pumps CGM can be used for an automatic response to low glycemic levels, i.e. infusion of the basal rate is stopped automatically by the pump for a maximum of 2 h. The rapid progress seen in information technology will most probably give diabetes technology in general a considerable “push” forward.
Literatur
Polonsky WH, Fisher L, Schikman CH et al (2011) Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the structured Testing Program study. Diabetes Care 34:262–267
Freckmann G, Baumstark A, Jendrike N et al (2010) System accuracy evaluation of 27 blood glucose monitoring systems according to DIN EN ISO 15197. Diabetes Technol Ther 12:221–231
Hortensius J, Slingerland RJ, Kleefstra N et al (2011) Self-monitoring of blood glucose: the use of the first or the second drop of blood. Diabetes Care 34:556–560
Clarke WL, Cox D, Gonder-Frederick LA et al (1987) Evaluating clinical accuracy of systems for self-monitoring of blood glucose. Diabetes Care 10:622–628
Nerhus K, Rustad P, Sandberg S (2011) Effect of ambient temperature on analytical performance of self-monitoring blood glucose systems. Diabetes Technol Ther 13:883–892
Judge K, Morrow L, Lastovich AG et al (2011) Continuous glucose monitoring using a novel glucose/galactose binding protein: results of a 12-hour feasibility study with the Becton Dickinson glucose/galactose binding protein sensor. Diabetes Technol Ther 13:309–317
Battelino T, Phillip M, Bratina N et al (2011) Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care 34:795–800
Garg SK, Voelmle MK, Beatson CR et al (2011) Use of continuous glucose monitoring in subjects with type 1 diabetes on multiple daily injections versus continuous subcutaneous insulin infusion therapy: a prospective 6-month study. Diabetes Care 34:574–579
Pickup JC, Freeman SC, Sutton AJ (2011) Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data. BMJ 343:d3805
Bon AC van, Bode BW, Sert-Langeron C et al (2011) Insulin glulisine compared to insulin aspart and to insulin lispro administered by continuous subcutaneous insulin infusion in patients with type 1 diabetes: a randomized controlled trial. Diabetes Technol Ther 13:607–614
Ihlo CA, Lauritzen T, Sturis J et al (2011) Explorative study of pharmacokinetics and pharmacodynamics after change in basal insulin infusion rate. J Diabetes Sci Technol 5:120–128
Danne T, Kordonouri O, Holder M et al (2011) Prevention of hypoglycemia by using low glucose suspend function in sensor-augmented pump therapy. Diabetes Technol Ther 13:1129–1134
Agrawal P, Welsh JB, Kannard B et al (2011) Usage and effectiveness of the low glucose suspend feature of the Medtronic Paradigm Veo insulin pump. J Diabetes Sci Technol 5:1137–1141
King BR, Goss PW, Paterson MA et al (2011) Changes in altitude cause unintended insulin delivery from insulin pumps: mechanisms and implications. Diabetes Care 34:1932–1933
Liang X, Wang Q, Yang X et al (2011) Effect of mobile phone intervention for diabetes on glycaemic control: a meta-analysis. Diabet Med 28:455–463
Weinstock RS, Teresi JA, Goland R et al (2011) Glycemic control and health disparities in older ethnically diverse underserved adults with diabetes: five-year results from the Informatics for Diabetes Education and Telemedicine (IDEATel) study. Diabetes Care 34:274–279
Charpentier G, Benhamou PY, Dardari D et al (2011) The Diabeo software enabling individualized insulin dose adjustments combined with telemedicine support improves HbA1c in poorly controlled type 1 diabetic patients: a 6-month, randomized, open-label, parallel-group, multicenter trial (TeleDiab 1 Study). Diabetes Care 34:533–539
Luley C, Blaik A, Reschke K et al (2011) Weight loss in obese patients with type 2 diabetes: effects of telemonitoring plus a diet combination – the Active Body Control (ABC) program. Diabetes Res Clin Pract 91:286–292
Lyon ME, Lyon AW (2011) Patient acuity exacerbates discrepancy between whole blood and plasma methods through error in molality to molarity conversion: „Mind the gap!“. Clin Biochem 44:412–417
Interessenkonflikt
Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehung/en hin: Der Autor ist Anteilseigner bei der klinischen Forschungsinstituten Profil Institut für Stoffwechselforschung in Neuss, Deutschland, und Profil Institute for Clinical Research, San Diego, USA. Er berät diverse Firmen, die innovative diagnostische und therapeutische Optionen für die Diabetestherapie entwickeln. Er erhält Honorare für diese Beratungstätigkeit und für Vorträge.
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Heinemann, L. Diabetestechnologie. Diabetologe 8, 367–376 (2012). https://doi.org/10.1007/s11428-011-0855-0
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DOI: https://doi.org/10.1007/s11428-011-0855-0