Diabetesberatung zum Hybrid-AID-System bei Typ-1-Diabetes: neue Perspektiven und Therapieempfehlungen

Zusammenfassung

Kontinuierliche Glukosemonitoringsysteme (CGM) haben inzwischen eine so hohe Messqualität erreicht, dass automatisierte therapeutische Entscheidungen und eine bedarfsgerechte automatisierte Insulinzufuhr möglich geworden sind. Dazu werden CGM und Insulinpumpen zu einem „AID-System“ (Automated Insulin Delivery) zusammengeführt. Ein Algorithmus errechnet dabei kontinuierlich aus den gemessenen Glukosewerten unter Berücksichtigung individueller Nutzerdaten die Insulindosis. Idealerweise verringert sich damit der Einfluss des „Human-Faktors“, d. h. die notwendige manuelle Steuerung der Insulinabgabe durch den Nutzer. Seit 2016 steht in den USA, seit 2018 in einigen europäischen Ländern und seit 2019 in Deutschland ein Hybrid-AID für Personen mit Typ-1-Diabetes zur Verfügung. Der Begriff „Hybrid“ bezeichnet dabei die automatische adaptive Zufuhr des nahrungsunabhängigen, basalen Insulinanteils und die manuelle Abgabe des Insulinbolus zu den Mahlzeiten. Derzeit setzen ca. 200 000 Personen mit Diabetes weltweit ein solches System ein.

Dieses, aber auch zukünftige Systeme zur vollautomatischen Insulinabgabe setzen voraus, dass die Nutzer ihr AID-System verstehen und in ungewöhnlichen oder kritischen Situationen sachgerecht reagieren können. Damit ist eine qualifizierte Schulung gerade zu diesen neuen Technologien aus unserer Sicht unverzichtbar. Nutzer können nur dann von den Vorteilen des Systems profitieren, wenn sie verstehen, weshalb ein automatisierter Modus verlassen wird, und sie im manuellen Modus sicher und korrekt handeln können. In diesem Beitrag werden relevante Aspekte und zentrale Herausforderungen bei der Schulung zum Hybrid-AID System MiniMed 670G dargestellt.

Abstract

Measurements of continuous glucose monitoring systems (CGM) have now achieved such a high accuracy that automated dose adaptation and on-demand automated insulin delivery have become a clinical reality. For this purpose, CGM and insulin pumps are linked into an “AID system” (Automated Insulin Delivery). An algorithm continuously calculates the insulin dose based on glucose values, taking into account individual user characteristics. Ideally, this reduces the influence of the “human factor”, e. g. the necessary manual control of insulin delivery by the user. Since 2016, a hybrid AID is available for people with type 1 diabetes in the USA, since 2018 in some European countries, and since 2019 in Germany. “Hybrid” refers to the automatic adaptive delivery of the meal-independent, basal insulin infusion, and the manual delivery of the insulin bolus for meals. Currently, about 200 000 people with diabetes use such a system worldwide.

However, for the current systems as well as for future fully automatic insulin delivery education is the key to enable users to understand their AID system and to react appropriately in unusual or critical situations. Users can only reap the benefits of the system if they understand the prerequisites for the system running in an automated mode and how to switch safely into manual mode. This paper covers relevant educational aspects and key challenges in training for the MiniMed 670G hybrid AID system.

Schlüsselwörter

kontinuierliches Glukosemonitoring (CGM) - Insulinpumpe - AID-System (automatische Insulindosierung) - Hybrid-AID-System - Closed-Loop-System

Key words

continuous glucose monitoring (CGM) - insulin pump - AID-System (automatic insulin delivery) - hybrid AID system - closed-loop system

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