Automatische Insulinabgabe-Systeme („AID-Systeme“)

Seit Jahrzehnten wird daran geforscht, Alternativen zur lebenslangen Insulintherapie zu finden – bis heute ohne durchschlagenden Erfolg. Eine spürbare Entlastung der Menschen mit Diabetes mellitus Typ 1 ist auch mittelfristig eher durch moderne Diabetestechnologien zu erwarten, insbesondere durch die Kombination und Kopplung von rtCGM-Systemen (real time continuous Glucose Monitoring) und Insulinpumpen, basierend auf speziellen Algorithmen. Die AID-Therapie (automated Insulin Delivery) ist Gegenstand der vorliegenden Arbeit.

Abstract

Reaching individual glycemic targets remains a challenge for people with type 1 diabetes despite chronic improvements in devices and diabetes technology. Whereas rtCGM (real time continuous glucose monitoring) systems have been a game changer in the development of diabetes technologies only a small group of patients experienced significant benefits due to insulin pump therapy (continuous subcutaneous insulin infusion; CSII). Manual insulin pump therapy has now been further developed into semi-automatic systems. These are called automated insulin delivery systems (AID systems). An algorithm adjusts the insulin delivery of the insulin pump semi-automatically based on the sensor data and patient input. The article gives a summary over differences and similarities of the AID-systems available in Germany in September 2023. One of the major similarities is the clinical result of better glycemic control and fewer hypoglycemic events, especially at nighttime. Time in range increases – in real life and in clinical trials – by about 10–15% on average. As is known from other interventions, with AID therapy the extent of improvement is even greater when initial glycemic control is poor, so this patient group should not be excluded from AID therapy. Furthermore, AID-therapy may help reducing the burden of disease (hypoglycemia fear, general diabetes distress, regimen distress etc.). In conclusion this article might provide help and support diabetes teams and health care providers to understand this promising technology for reducing the glycemic load and, consequently, the risk for diabetes complications. Despite ongoing improvements in technology, diabetes education and mentoring people with diabetes will be the key for success in diabetes treatment – for patients and care providers.

Kernaussagen

• Durch den Einsatz von AID-Systemen gibt es einen Paradigmenwechsel für die Verwendung von Insulinpumpen.

• Insbesondere das Ziel für die Nüchternglukose wird durch ein AID-System sehr häufig erreicht.

• Das Mahlzeitenmanagement bleibt die Herausforderung in der Therapie.

• Die Verwendung eines speziellen Systems sollte vor Einsatz sehr sorgfältig abgewogen werden.

• Die Betreuung und Verordnung von AID-Systemen sollten Teams mit entsprechender Expertise vorbehalten bleiben.

• Auch in der Schwangerschaft können AID-Systeme die Betroffenen unterstützen, die engeren Zielbereiche für die Glukosewerte zu erreichen.

• Es ist eine schlauchlose Alternative für die Verwendung eines AID-Systems verfügbar.

• In Studien zeigte sich eher ein günstiger Einfluss auf von Patienten berichtete Faktoren wie diabetesbezogene Belastung oder Hypoglykämieangst.

Schlüsselwörter

Nüchternglukose - Typ-1-Diabetes - Insulinpumpe/CSII - Algorithmus - Automatisierte Insulin Anpassung - Hypoglykämie

Keywords

Fasting Glucose - Type 1 Diabetes - Insulin pump therapy - Algorithm - Automated Insulindelivery - Hypoglycemia

Publication History

Article published online:
16 April 2024

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