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Diabetologie und Stoffwechsel 2017; 12(01): 56-66
DOI: 10.1055/s-0043-100389
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Moderne Therapie des Typ-1-Diabetes: Pumpentherapie mit Insulinanaloga – Indikationen, Daten zur Handhabung und Ausblicke

Modern Treatment of Type 1 Diabetes: Pump Therapy with Insulin Analogues – Indications, Handling Data and Outlook
Torben Biester
1   Diabetologie, Endokrinologie und klinische Forschung, AUF DER BULT Kinder- und Jugendkrankenhaus, Hannover
,
Erik Wizemann
2   Diabetologische Schwerpunktpraxis, Herrenberg
› Author Affiliations
Further Information

Publication History

29 September 2016

28 December 2016

Publication Date:
14 February 2017 (online)

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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. In Leitlinien finden sich für die Indikationsstellung Angaben zum HbA1c-Wert, zum Dawn-Phänomen, zur Schwangerschaft und zu Hypoglykämien. Mit der CSII sind gegenüber MDI Reduktionen der glykämischen Variabilität, der HbA1c-Werte und von schweren 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. Bedenken bzgl. eines eventuell erhöhten Ketoazidoserisikos konnten jedoch mit neueren Studien ausgeräumt werden. Zur Vermeidung von Komplikationen sollten die empfohlenen Wechselintervalle zu den Infusionssets und Reservoirs konsequent eingehalten werden. Typischerweise werden bei der CSII kurz wirksame Insulinanaloga verordnet, da diese gegenüber Humaninsulin einen signifikanten, wenn auch kleinen Nutzen hinsichtlich der glykämischen Kontrolle aufwiesen. 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. Insulin glulisin war im Vergleich zu Insulin aspart und Insulin lispro mit höheren Verschlussraten und vermehrten symptomatischen Hypoglykämien assoziiert. Zudem liegen zu Insulin aspart und Insulin lispro bei der CSII deutlich mehr Studiendaten vor als zu Insulin glulisin. Insulin aspart zeigte unter den kurz wirksamen Insulinanaloga die größte 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.

Abstract

Continuous subcutaneous insulin infusion using a pump (CSII) is started in adults with type 1 diabetes after previous attempts with multiple daily insulin injections (MDI) and in children often shortly after they have been diagnosed with diabetes. A prerequisite of the success of CSII is the motivation and reliability of patients (or – in the case of children – of their parents) as well as a proper training. CSII has a broad overall spectrum of indications. Guidelines for determining the indication for pump therapy describe information on HbA1c, the dawn phenomenon, pregnancy and episodes of hypoglycaemia. Compared with MDI, CSII can help to reduce glycaemic variability, HbA1c values and severe hypoglycaemia and to improve quality of life and treatment satisfaction. Specific adverse events of CSII may result from the pump, the infusion sets and/or the infusion site and, subsequently, may induce complications such as ketoacidosis or severe hypoglycaemia. Nevertheless, concerns about a possibly increased risk of ketoacidosis could be eliminated based on recent studies. In order to avoid complications, the recommended replacement intervals for infusion sets and reservoirs should be complied with rigorously. Short-acting insulin analogues are typically prescribed for CSII, as they have a significant, though small advantage in terms of glycaemic control over human insulin. Users benefit from the fact that the need for an “injection-to-meal interval” is reduced or non-existent. Short-acting insulin analogues differ in terms of insulin molecule and excipients in their formulations. Insulin glulisine was associated with higher occlusion rates and more episodes of symptomatic hypoglycaemia compared with insulin aspart and insulin lispro. Moreover, markedly more study data are available for insulin aspart and insulin lispro in CSII compared with insulin glulisine. Insulin aspart demonstrated the highest stability in the pump among the short-acting insulin analogues. Advancements in CSII can be seen to emerge in the form of further developments in the field of closed-loop systems and new procedures or new insulins for a faster onset of insulin action.

Schlüsselwörter

Diabetes - Insulin - Insulinpumpen - CSII - Infusionsset

Key Words

diabetes - insulin - insulin pumps - CSII - infusion set
 

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