Empfehlungen zur Diabetes-Behandlung mit automatischen Insulin-Dosierungssystemen

Zusammenfassung

Das Prinzip der automatischen Insulindosierung, kurz „AID“ genannt, zeigt in Zulassungsstudien und Real-World-Erfahrungen ausgezeichnete Behandlungsergebnisse. Beim AID wird eine Insulinpumpe mit einem System zur kontinuierlichen Glukosemessung zusammengeschaltet, während ein Rechenprogramm, der sogenannte Algorithmus, die Steuerung der Insulingabe nach Bedarf übernimmt. Idealerweise wäre das System ein geschlossener Kreis, bei dem die Menschen mit Diabetes keine Eingabe mehr machen müssten. Jedoch sind bei den heute verfügbaren Systemen verschiedene Grundeinstellungen und Eingaben erforderlich (insbesondere von Kohlenhydratmengen der Mahlzeiten oder körperlicher Aktivität), die sich von den bisherigen Empfehlungen der sensorunterstützten Pumpentherapie in einzelnen Aspekten unterscheiden. So werden die traditionellen Konzepte von „Basal“ und „Bolus“ mit AID weniger nützlich, da der Algorithmus beide Arten der Insulinabgabe verwendet, um die Glukosewerte dem eingestellten Zielwert zu nähern. Daher sollte bei diesen Systemen statt der Erfassung von „Basal“ und „Bolus“, zwischen einer „nutzerinitiierten“ und einer „automatischen“ Insulindosis unterschieden werden. Gemeinsame Therapieprinzipien der verschiedenen AID-Systeme umfassen die passgenaue Einstellung des Kohlenhydratverhältnisses, die Bedeutung des Timings der vom Anwender initiierten Insulinbolusgaben vor der Mahlzeit, den korrekten Umgang mit einem verzögerten oder versäumten Mahlzeitenbolus, neue Prinzipien im Umgang mit Sport oder Alkoholgenuss sowie den rechtzeitigen Umstieg von AID zu manuellem Modus bei Auftreten erhöhter Ketonwerte. Das Team vom Diabetes-Zentrum AUF DER BULT in Hannover hat aus eigenen Studienerfahrungen und der zugrunde liegenden internationalen Literatur praktische Empfehlungen zur Anwendung und Schulung der gegenwärtig und demnächst in Deutschland kommerziell erhältlichen Systeme zusammengestellt. Für den Erfolg der AID-Behandlung scheint das richtige Erwartungsmanagement sowohl beim Behandlungsteam und als auch beim Anwender von großer Bedeutung zu sein.

Abstract

The principle of Automatic Insulin Dosing (AID) has shown excellent treatment results in pivotal studies and real-world experience. With AID, an insulin pump is interconnected with a continuous glucose monitoring system, while an algorithm takes over the control of insulin administration as needed. Ideally, the system would be a closed-loop system in which people with diabetes would no longer need to provide input. However, the systems available today require various basic settings and inputs (especially of carbohydrate amounts of meals or physical activity), which differ from the previous recommendations of sensor-augmented pump therapy in several aspects. For example, the traditional concepts of „basal“ and „bolus“ become less useful with AID, as the algorithm uses both types of insulin delivery to bring glucose levels closer to the set target. Therefore, instead of discussing „basal“ and „bolus“, a distinction should be made between a „user-initiated“ and an „automatic“ insulin dose in these systems. Common therapeutic principles of the different AID systems include the precise fitting of the carbohydrate ratio, the importance of timing the user-initiated pre-meal insulin boluses, the correct handling of a delayed or missed meal bolus, new principles in dealing with exercise or alcohol intake, and the timely switch from AID to manual mode when elevated ketone levels occur. The team from the Diabetes-Zentrum AUF DER BULT in Hannover has compiled practical recommendations for the application and training of the systems, both, for those currently and those soon to be commercially available in Germany from their own study experience and the underlying international literature. For the success of AID treatment, the right expectation management seems to be of great importance for the treatment team as well as for the user.

Schlüsselwörter

Insulinpumpen - Glukosesensoren - automatische Insulindosierung - Hypoglykämie - Ketoazidose

Keywords

insulin pump - glucose sensors - automated insulin dosing - hypoglycemia - ketoacidosis

Publication History

Received: 01 July 2021

Accepted after revision: 22 September 2021

Article published online:
03 December 2021

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