RSS-Feed abonnieren
DOI: 10.1055/a-0618-4826
Moderne Therapie des Typ-1-Diabetes – Pumpentherapie mit Insulinanaloga
Indikationen, Daten zur Handhabung und AusblickePublikationsverlauf
Publikationsdatum:
13. Juni 2018 (online)
![](https://www.thieme-connect.de/media/diabetakt/201802/lookinside/thumbnails/10-1055-a-0618-4826-1.jpg)
ZUSAMMENFASSUNG
Die kontinuierliche subkutane Insulininfusion mittels Pumpe (CSII) wird bei Erwachsenen mit Typ-1-Diabetes nach vorherigen Versuchen mit multiplen täglichen Insulininjektionen (MDI) angewandt bzw. bei Kindern häufig bereits kurz nach der Diabetesdiagnose eingeleitet. Grundvoraussetzung für den Erfolg der CSII sind die Motivation und Zuverlässigkeit der Patienten (bzw. bei Kindern der Eltern) sowie eine ausreichende Schulung. Insgesamt ergibt sich für die CSII ein breites Anwendungsspektrum. Mit der Pumpentherapie sind im Vergleich zu multipen täglichen Insulininektionen Reduktionen der glykämischen Variabilität, der HbA1c-Werte und schwerer Hypoglykämien möglich sowie Verbesserungen bei Lebensqualität und Therapiezufriedenheit. Spezifische unerwünschte Ereignisse der CSII können von der Pumpe, den Infusionssets und/ oder der Infusionsstelle ausgehen und nachfolgend Komplikationen wie Ketoazidosen oder schwere Hypoglykämien auslösen. Typischerweise werden bei der Pumpentherapie kurz wirksame Insulinanaloga verordnet. Für die Anwender besteht der Nutzen vor allem im nicht notwendigen oder geringeren „Bolus-Ess-Abstand“. Die kurz wirksamen Insulinanaloga unterscheiden sich hinsichtlich Insulinmolekül und Hilfsstoffen in den Formulierungen und daher auch in der Rate an Verschlüssen oder symptomatisschen Hypoglykämien bzw. ihrer Stabilität in der Pumpe. Fortschritte im Bereich der CSII zeichnen sich durch Weiterentwicklungen im Bereich der Closed-Loop-Systeme und durch neue Verfahren bzw. neue Insuline für den schnelleren Eintritt der Insulinwirkung ab.
-
Literatur
- 1 Böhm BO, Dreyer M, Fritsche A. et al. Therapie des Typ-1-Diabetes.. Diabetologie und Stoffwechsel 2014; 9: 125-135 doi: 10.1055/s-0034-1385406
- 2 Danne T, Bangstad HJ, Deeb L. et al. ISPAD clinical practice consensus guidelines 2015 compendium. Insulin treatment in children and adolescents with diabetes.. Pediatr Diabetes 2014; 15: 115-134 doi: 10.1111/pedi.12184
- 3 Cherubini V, Gesuita R, Bonfanti R. et al. Health-related quality of life and treatment preferences in adolescents with type 1 diabetes. The VIPKIDS study.. Acta Diabetol 2014; 51: 43-51 doi: 10.1007/s00592-013-0466-x
- 4 Lassmann Vague L, Chavel S, Guerci B. et al. When to treat a diabetic patient using an external insulin pump.. Diabetes Metab 2010; 36: 79-85 doi: 10.1016/j.diabet.2009.09.002
- 5 Stadler M, Zlamal-Fortunat S, Schütz-Fuhrmann I. et al. Leitlinien Insulinpumpentherapie bei Kindern und Erwachsenen (Für den Ausschuss Insulinpumpentherapie der Österreichischen Diabetesgesellschaft).. Wien Klin Wochenschr 2012; 124: 123-128 doi: 10.1007/s00508-012-0287-x
- 6 Renard E. Insulin pump use in Europe.. Diabetes Technol Ther 2010; 12: S29-S32 doi: 10.1089/dia.2009.0189
- 7 Von Sengbusch S, Heidtmann B, Burghoff C. et al. Insulinpumpenverordnung: Führt das starre, intransparente Genehmigungsverfahren zur (unbeabsichtigten) Vorenthaltung einer etablierten Diabetesbehandlung?. Diabetologie 2008; 3: 218-224
- 8 Maahs DM, Hermann JM, Holman N. et al. Rates of diabetes ketoacidosis: International comparison with 49859 pediatric patients with type 1 diabetes from England, Wales, the U.S., Austria, and Germany.. Diabetes Care 2015; 38: 1876-1882 doi: 10.2337/dc15-0780
- 9 Misso ML, Egberts KJ, Page M. et al. Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus.. Cochrane Database of Syst Rev. 2010; 1: CD005103 doi: 10.1002/14651858.CD005103.pub2
- 10 Jeitler K, Horvath K, Berghold A. et al. Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis.. Diabetologia 2008; 51: 941-951 doi: 10.1007/s00125-008-0974-3
- 11 Johnson SR, Cooper MN, Jones TW, Davis EA. Long-term outcome of insulin pump therapy in children with type 1 diabetes assessed in a large population-based case-control study.. Diabetologia 2013; 56: 2392-2400 doi: 10.1007/s00125-013-3007-9
- 12 Yeh HC, Brown TT, Maruthur N. et al. Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: a systematic review and meta-analysis.. Ann Intern Med 2012; 157: 336-347 doi: 10.7326/0003-4819-157-5-201209040-00508
- 13 Thabit H, Hovorka R. Continuous subcutaneous insulin infusion therapy and multiple daily insulin injections in type 1 diabetes mellitus: a comparative overview and future horizons.. Expert Opin Drug Deliv 2016; 13: 389-400 doi: 10.1517/17425247.2016.1115013
- 14 Clements M, Matuleviciene V, Attvall S. et al. Predicting the effectiveness of insulin pump therapy on glycemic control in clinical practice: a retrospective study of patients with type 1 diabetes from 10 outpatient diabetes clinics in Sweden over 5 years.. Diabetes Technol Ther 2015; 17: 21-28 doi: 10.1089/dia.2014.0139
- 15 Retnakaran R, Hochman J, DeVries JH. et al. Continuous subcutaneous insulin infusion versus multiple daily injections: the impact of baseline A1c.. Diabetes Care 2004; 27: 2590-2596 doi: 10.2337/diacare.27.11.2590
- 16 Olsen B, Johannesen J, Fredheim S. et al. Insulin pump treatment; increasing prevalence, and predictors for better metabolic outcome in Danish children and adolescents with type 1 diabetes.. Pediatr Diabetes 2015; 16: 256-262 doi:10.1111/pedi.12164
- 17 Sherr JL, Hermann JM, Campbell F. et al. Use of insulin pump therapy in children and adolescents with type 1 diabetes and its impact on metabolic control: comparison of results from three large, transatlantic paediatric registries.. Diabetologia 2016; 59: 87-91 doi: 10.1007/s00125-015-3790-6
- 18 Hoogma RP, Hammond PJ, Gomis R. et al. Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH-based multiple daily injections (MDI) on glycaemic control and quality of life: results of the 5-nations trial.. Diabet Med 2006; 23: 41-147 doi: 10.1111/j.1464-5491.2005.01738.x
- 19 Pickup JC, Kidd J, Burmiston S, Yemane N. Determinants of glycemic control in type 1 diabetes during intensified therapy with multiple daily insulin injections or continuous subcutaneous insulin infusion: importance of blood glycose variability.. Diabetes Metab Res Rev 2006; 22: 232-237 doi: 10.1002/dmrr.614
- 20 Little SA, Leelarathna L, Walkinshaw E. et al. Recovery of hypoglycemia awareness in long-standing type 1 diabetes: a multicenter 2 × 2 factorial randomized controlled trial comparing insulin pump with multiple daily injections and continuous with conventional glucose self-monitoring (HypoCOMPaSS).. Diabetes Care 2014; 37: 2114-2122 doi: 10.2337/dc14-0030
- 21 Pickup JC, Sutton AJ. Severe hypoglycaemia and glycemic control in type 1 diabetes: meta-analysis of multiple daily injections compared with continuous subcutaneous insulin infusion.. Diabet Med 2008; 25: 765-774 doi: 10.1111/j.1464-5491.2008.02486.x
- 22 Rodrigues IAS, Reid HA, Ismail K. et al. Indications and efficacy of continuous subcutaneous insulin infusion (CSII) therapy in Type 1 diabetes mellitus: a clinical audit in a specialist service.. Diabet Med 2005; 22: 842-849 doi: 10.1111/j.1464-5491.2005.01539.x
- 23 Pozzilli P, Battelino T, Danne T. et al. Continuous subcutaneous insulin infusion in diabetes: patient populations, safety, efficacy and pharmacoeconomics.. Diabetes Metab Res Rev 2016; 32: 21-39 doi: 10.1002/dmrr.2653
- 24 Van Dijk PR, Logtenberg SJ, Groenier KH. et al. Fifteen-year follow-up of quality of life in type 1 diabetes mellitus.. World J Diabetes 2014; 5: 569-576 doi: 10.4239/wjd.v5.i4.569
- 25 Maiorino MI, Bellastella G, Petrizzo M. et al. Treatment satisfaction and glycemic control in young type 1 diabetic patients in transition from pediatric health care: CSII versus MDI.. Endocrine 2014; 46: 256-262 doi: 10.1007/s12020-013-0060-6
- 26 Marmolin ES, Brødsgaard J, Gjessing HJ. et al. Better treatment of outpatients with type 1 diabetes after introduction of continuous subcutaneous insulin infusion.. Dan Med J 2012; 59: A4445
- 27 Heinemann L, Fleming GA, Petrie JR. et al. Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event reporting and research needs. A Joint Statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group.. Diabetologia 2015; 58: 862-870 doi: 10.2337/dc15-0168
- 28 NICE technology appraisal guidance [151TA151]. Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus. Published 23 July 2008. www.nice.org.uk/guidance/ta151 (letzter Zugriff am 24.04.2018)
- 29 Neu A, Bürger-Büsing J, Danne T. et al. Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter – AWMF-Registernummer 057–016.. Diabetologie 2016; 11: 35-94 doi: 10.1055/s-0042-100779
- 30 Phillip M, Battelino T, Rodriguez H. et al. Use of insulin pump therapy in the pediatric age-group: consensus statement from the European Society for Paediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society, and the International Society for Pediatric and Adolescent Diabetes, endorsed by the American Diabetes Association and the European Association for the Study of Diabetes.. Diabetes Care 2007; 30: 1653-1662 doi: 10.2337/dc07-9922
- 31 Grunberger G, Abelseth JM, Bailey TS. et al. Consensus statement by the American Association of Clinical Endocrinologists/American College of Endocrinology Insulin Pump Management Task Force.. Endocr Pract 2014; 20: 463-489 doi: 10.4158/EP14145.PS
- 32 Ludwig-Seibold CU, Holder M, Rami B. et al. Continuous glucose monitoring in children, adolescents, and adults with type 1 diabetes mellitus: analysis from the prospective DPV diabetes documentation and quality management system from Germany and Austria.. Pediatr Diabetes 2012; 13: 12-14 doi: 10.1111/j.1399-5448.2011.00835.x
- 33 Holl RW. Prinz N für das DPV-Register der pädiatrischen Diabetologie. Medizinische Versorgung von Kindern und Jugendlichen mit Diabetes – Entwicklungen der letzten 22 Jahre.. Deutscher Gesundheitsbericht Diabetes 2018; 146-157
- 34 Ross PL, Milburn J, Reith DM. et al. Clinical review: insulin pump-associated adverse events in adults and children.. Acta Diabetol 2015; 52: 1017-1024 doi: 10.1007/s00592-015-0784-2
- 35 Pickup JC, Yemane N, Brackenridge A. et al. Nonmetabolic complications of continuous subcutaneous insulin infusion: a patient survey.. Diabetes Technol Ther 2014; 16: 145-149 doi: 10.1089/dia.2013.0192
- 36 Reichel A, Rietzsch H, Köhler HJ. et al. Cessation of insulin infusion at night-time during CSII-therapy: comparison of regular human insulin and insulin lispro.. Exp Clin Endocrinol Diabetes 1998; 106: 168-172 doi: 10.1055/s-0029-1211971
- 37 Cummins E, Royle P, Snaith A. et al. Clinical effectiveness and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes: systematic review and economic evaluation.. Health Technol Assess 2010; iii-iv xi-xvi, 1–181; doi: 10.3310/hta14110
- 38 Poulsen C, Langkjaer L, Worsøe C. Precipitation of insulin products used for continuous subcutaneous insulin infusion.. Diabetes Technol Ther 2005; 7: 142-150 doi: 10.1089/dia.2005.7.142
- 39 Woods RJ, Alarcón J, McVey E. et al. Intrinsic fibrillation of fast-acting insulin analogs.. J Diabetes Sci Technol 2012; 6: 265-276 doi: 10.1177/193229681200600209
- 40 Senstius J, Harboe E, Westermann H. In vitro stability of insulin aspart in simulated continuous subcutaneous insulin infusion using a MiniMed® 508 insulin pump.. Diabetes Technol Ther 2007; 9: 75-79 doi: 10.1089/dia.2006.0041
- 41 DeFelippis MR, Bell MA, Heyob JA. et al. In vitro stability of insulin lispro in continuous subcutaneous insulin infusion.. Diabetes Technol Ther 2006; 8: 358-368 doi: 10.1089/dia.2006.8.358
- 42 Sharrow SD, Glass LC, Dobbins MA. 14-day in vitro chemical stability of insulin lispro in the MiniMed Paradigm pump.. Diabetes Technol Ther 2012; 14: 264-270 doi: 10.1089/dia.2011.0125
- 43 Senstius J, Poulsen C, Hvass A. Comparison of in vitro stability for insulin aspart and insulin glulisine during simulated use in insulin pumps.. Diabetes Technol Ther 2007; 9: 517-521 doi: 10.1089/dia.2006.0041
- 44 Bode BW. Comparison of pharmacokinetic proterties, physicochemical stability, and pump compatibility of 3 rapid-acting insulin analoguesaspart, lispro, and glulisine.. Endocr Pract 2011; 17: 271-280 doi: 10.4158/EP10260.RA
- 45 Poulsen C, Langkjaer L, Worsøe C. Precipitation of insulin aspart and insulin glulisine products used for continuous subcutaneous insulin infusion.. Diabetes Technol Ther 2007; 9: 26-35 doi: 10.1089/dia.2006.0054
- 46 Kerr D, Morton J, Whately-Smith C. et al. Laboratory-based non-clinical comparison of occlusion rates using three rapid-acting insulin analogs in continuous subcutaneous insulin infusion catheters using low flow rates.. J Diabetes Sci Technol 2008; 2: 450-455 doi: 10.1177/193229680800200314
- 47 Senesh G, Bushi D, Neta A. et al. Compatibility of insulin lispro, aspart, and glulisine with the SoloTM Micro Pump, a novel miniature insulin pump.. J Diabetes Sci Technol 2010; 4: 104-110 doi: 10.1177/193229681000400113
- 48 Van Bon AC, Bode BW, Sert-Langeron C. et al. 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 2011; 13: 607-614 doi: 10.1089/dia.2010.0224
- 49 Walsh J, Roberts R, Weber D. et al. Insulin pump and CGM usage in the United States and Germany: Results of a real-world survey with 985 subjects.. J Diabetes Sci Technol 2015; 9: 1103-1110 doi: 10.1177/1932296815588945
- 50 Thethi TK, Rao A, Kawji H. et al. Consequences of delayed pump infusion line change in patients with type 1 DM treated with continuous subcutaneous insulin infusion.. J Diabetes Complications 2010; 24: 73-78 doi: 10.1016/j.jdiacomp.2009.03.002
- 51 Schmid V, Hohberg C, Borchert M. et al. Pilot study for assessment of optimal frequency for changing catheters in insulin pump therapy-trouble starts on day 3.. J Diabetes Sci Technol 2010; 4: 976-982 doi: 10.1177/193229681000400429
- 52 Pfützner A, Sachsenheimer D, Grenningloh M. et al. Using insulin infusion sets in CSII for longer than the recommended usage time leads to a high risk for adverse events: results from a prospective randomized crossover study.. J Diabetes Sci Technol 2015; 9: 1292-1298 doi: 10.1177/1932296815604438
- 53 Tamborlane WV, Renard E, Wadwa RP. et al. Glycemic control after 6 days of insulin pump reservoir use in type 1 diabetes: results of doubleblind and open-label cross-over trials of insulin lispro and insulin aspart.. J Diabetes 2015; 7: 270-278 doi: 10.1111/1753-0407.12162
- 54 Bode BW, Weinstein R, Bell D. et al. Comparison of insulin aspart with buffered regular insulin and insulin lispro in continuous subcutaneous insulin infusion.. Diabetes Care 2002; 25: 439-444 doi:10.2337/diacare.25.3.439
- 55 Weinzimer SA, Ternand C, Howard C. et al. A randomized trial comparing continuous subcutaneous insulin lispro in children and adolescents with type 1 diabetes.. Diabetes Care 2008; 31: 210-215 doi: 10.2337/dc07-1378
- 56 Cengiz E, Bode B, Van Name M. et al. Moving toward the ideal insulin for insulin pumps.. Expert Rev Med Devices 2016; 13: 57-69 doi: 10.1586/17434440.2016.1109442
- 57 Radermecker RP, Scheen AJ. Continuous subcutaneous insulin infusion with short-acting insulin analogues or human regular insulin: efficacy, safety, quality of life, and cost-effectiveness.. Diabetes Metab Res Rev 2004; 20: 178-188 doi: 10.1002/dmrr.447
- 58 Ruedy KJ, Tamborlane WV. The landmark JDRF continuous glucose monitoring randomized trials: a look back at the accumulated evidence.. J Cardiovasc Transl Res 2012; 5: 380-387 doi: 10.1007/s12265-012-9364-9
- 59 Langendam M, Ym L, Hooft L. et al. Continuous glucose monitoring systems for type 1 diabetes mellitus.. Cochrane Database Syst Rev 2012; 1: CD008101 doi: 10.1002/14651858.CD008101.pub2
- 60 Pickup JC, Holloway F, Samsi K. Real-time continuous glucose monitoring in type 1 diabetes: a qualitative framework analysis of patient narratives.. Diabetes Care 2015; 38: 544-550 doi: 10.2337/dc14-1855
- 61 Bergenstal RM, Klonoff DC, Garg SK. et al. Threshold-based insulin-pump interruption for reduction of hypoglycemia.. N Engl J Med 2013; 369: 224-232 doi: 10.1056/NEJMoa1303576
- 62 Ly TT, Nicholas JA, Retterath A. et al. Effect of sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: a randomized clinical trial.. JAMA 2013; 310: 1240-1247 doi: 10.1001/jama.2013.277818
- 63 Buckingham BA, Cameron F, Calhoun P. et al. Outpatient safety assessment of an in-home predictive low-glucose suspend system with type 1 diabetes subjects at elevated risk of nocturnal hypoglycemia.. Diabetes Technol Ther 2013; 15: 622-627 doi: 10.1089/dia.2013.0040
- 64 Maahs DM, Calhoun P, Buckingham BA. et al. A Randomized trial of a home system to reduce nocturnal hypoglycemia in type 1 diabetes.. Diabetes Care 2014; 37: 1885-1891 doi: 10.2337/dc13-2159
- 65 Kropff J, DeVries JH. Continuous glucose monitoring, future products, and update on worldwide artificial pancreas projects.. Diabetes Technol Ther 2016; 18: 253-263 doi: 10.1089/dia.2015.0345
- 66 Finan DA, McCann TW, Mackowiak L. et al. Closed-loop control performance of the hypoglycemia-hyperglycemia minimizer (HHM) system in a feasibility study.. J Diabetes Sci Technol 2014; 8: 35-42 doi: 10.1177/1932296813511730
- 67 Phillip M, Battelino T, Atlas E. et al. Nocturnal glucose control with an artificial pancreas at a diabetes camp.. N Engl J Med 2013; 368: 824-833 doi: 10.1056/NEJMoa1206881
- 68 Nimri R, Danne T, Kordonouri O. et al. The „Glucositter“ overnight automated closed loop system for type 1 diabetes: a randomized crossover trial.. Pediatr Diabetes 2013; 14: 159-167 doi: 10.1111/pedi.12025
- 69 Weinzimer SA, Steil GM, Swan KL. et al. Fully automated closed-loop insulin delivery versus semiautomated hybrid control in pediatric patients with type 1 diabetes using an artificial pancreas.. Diabetes Care 2008; 31: 934-939 doi: 10.2337/dc07-1967
- 70 Chase HP, Doyle FJ , Zisser H. et al. Multicenter closed-loop/hybrid meal bolus insulin delivery with type 1 diabetes.. Diabetes Technol Ther 2014; 16: 623-632 doi: 10.1089/dia.2014.0050
- 71 Kerr D, Wizemann E, Senstius J. et al. Stability and performance of rapidacting insulin analogs used for continuous subcutaneous insulin infusion: a systematic review.. J Diabetes Sci Technol 2013; 7: 1595-1606 doi: 10.1177/193229681300700620