Download PDF
Diabetes aktuell 2014; 12(1): 20-25
DOI: 10.1055/s-0034-1372222
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Messsysteme für das kontinuierliche Glukosemonitoring – Vergleich der verschiedenen Systeme

Continuous glucose measurement (CGM) – available CGM systems
Thorsten Siegmund
1   Städtisches Klinikum München GmbH, Klinikum Bogenhausen
,
Ralf Kolassa
2   Diabetologische Schwerpunktpraxis, Bergheim/Erft
,
Andreas Thomas
3   Medtronic GmbH Deutschland, Geschäftsbereich Diabetes, Meerbusch
› Author Affiliations
Further Information

Publication History

Publication Date:
04 March 2014 (online)

Also available at
    Permissions and Reprints

Es war lange Zeit ein Wunsch von Patienten und Ärzten mittels einer kontinuierlichen Glukosemessung einen vollständigen Überblick über den Verlauf des Glukosestoffwechsels zu erhalten. Seit 1999 hat sich zunehmend ein kontinuierliches Glukosemonitoring (CGM) etabliert, zunächst als diagnostische Methode, später auch als Therapieunterstützung mit aktuell verfügbaren Glukosewerten für Diabetespatienten. Anders als in verschiedenen anderen europäischen Ländern (z. B. Niederlande, Schweden, Schweiz) fehlt in Deutschland bisher die Kostenerstattung, sodass dessen Einsatz nur bei klarer Indikation als Einzelfallentscheidung von den Krankenkassen bezahlt wird. Dies ist ein wesentliches Hemmnis für eine breitere Anwendung von CGM. Die bisher verfügbaren CGM-Systeme werden nachfolgend dargestellt und in ihren wichtigen Eigenschaften verglichen. Dabei wird die Bedeutung des Einsatzes im Rahmen der sensorunterstützten Pumpentherapie (SuP) hervorgehoben, weil hiermit bereits eine Steuerung der Insulinpumpe durch Basalratenabschaltung im Falle einer drohenden Hypoglykämie möglich ist.

It is a long standing wish of patients and physicians to get a complete overview of glucose metabolism by the use of a continuous glucose measurement (CGM). Since 1999, CGM was established as both, a diagnostic and a therapy supporting method with ongoing available glucose levels for diabetes patients. In difference to other European countries (f. e. Netherland, Sweden, Switzerland) in Germany CGM is not reimbursed by the health care system so far. Therefore, CGM is only improved by health insurance companies in some patients with clear indications based on an individual by-case dicission. This is an important major obstacle for the wider application of CGM. The article describes the at the moment available CGM systems taking in consideration their relevant characteristics with a specific highlight considering the sensor in combination with insulin pump therapy, the so called sensor augmented pump therapy (SaP). This feature allows an additional reduction of hypoglycemia by threshold triggered halt of the basal rate when glucose falls below a predefined level (low glucose suspend, LGS).

Key words

Continuous glucose monitoring (CGM) - glucose sensors - CGM devices - Sensor augmented therapy (SaT) - Sensor augmented pump therapy (SaP) - hypoglycemia suspend
 

  • Literatur

  • 1 Cryer PE. Hypoglycaemia: the limiting factor in the glycaemic management of type 1 and Type 2 diabetes. Diabetologia 2002; 45: 937-948
    CrossrefGoogle Scholar
  • 2 Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care 2003; 26: 1902-1912
    CrossrefGoogle Scholar
  • 3 Cox DJ, Gonder-Frederick LA, Kovatchev BP et al. Biopsychobehavioral model of severe hypoglycemia. II. Understanding the risk of severe hypoglycemia. Diabetes Care 1999; 22: 2018-2025
    CrossrefGoogle Scholar
  • 4 Gross TM, Mastrototaro JJ. Efficacy and Reliability of the Continuous Glucose Monitoring System. Diabetes Technology and Therapeutics 2000; 2 (Suppl. 01)
    Google Scholar
  • 5 Tamada JA, Garg S, Jovanovic L et al. Noninvasive Glucose Monitoring. Comprehensive Clinical Results. JAMA 1999; 282: 1839-1844
    CrossrefGoogle Scholar
  • 6 Maran A, Crepaldi C, Tiengo A et al. Continuous subcutaneous glucose monitoring in diabetic patients: a multicenter analysis. Diabetes Care 2002; 25: 347-352
    CrossrefGoogle Scholar
  • 7 Bode B, Gross K, Rikaldo N et al. Alarm Based on Real-Time Sensor Glucose Values Alert Patients to Hypo- and Hyperglycemia: The Guardian Continuous Monitoring System. Diabetes Technol Ther 2004; 6: 105-113
    CrossrefGoogle Scholar
  • 8 Mastrototaro JJ. The MiniMed Continuous Glucose Monitoring System. Diabetes Technol Ther 2000; 2 (Suppl. 01) 13-18
    CrossrefGoogle Scholar
  • 9 Danne T, Liebl A, Reichel A et al. First user experience with an integrated insulin pump and real-time continuous glucose monitoring system in German patients with type 1 diabetes. Diabetes 2006; 55 (Suppl. 01)
    Google Scholar
  • 10 Choudhary P, Shin J, Wang Y et al. Insulin Pump TherapyWith Automated Insulin Suspension in Response to Hypoglycemia. Diabetes Care 2011; 34: 2023-2025
    CrossrefGoogle Scholar
  • 11 Danne T, Kordonouri O, Holder M et al. Prevention of Hypoglycemia by Using Low Glucose Suspend Function in Sensor-Augmented Pump Therapy. Diabetes Technol Ther 2011; 13: 1129-1134
    CrossrefPubMedGoogle Scholar
  • 12 Bergenstal RM, Klonoff DC, Garg SK. et al. Thres-hold-Based Insulin-Pump Interruption for Reduc-tion of Hypoglycemia. N Engl J Med 2013; 369: 224-232
    CrossrefGoogle Scholar
  • 13 Ly TT, Nicolas JA, Retterath A et al. Effect of Sensor-Augmented Insulin Pump Therapy and Automated Insulin Suspension vs Standard Insulin Pump Therapy in Patients with Type 1 Diabetes. A Randomized Clinical Trial. JAMA 2013; 310: 1240-1247
    CrossrefGoogle Scholar
  • 14 Siegmund T, Kolassa R, Thomas A. Sensorunterstützte Therapie (SuP) und Sensorunterstützte Pumpentherapie (SuP). Buch Unimed Science Verlag Bremen ISBN 978-3-8374-1232-1 2011;
    Google Scholar
  • 15 Clarke W, Cox D, Gonder-Frederick L, Carter W, Pohl S. Evaluating the clinical accuracy of systems for self-monitoring of blood glucose. Diabetes Care 1987; 10: 622-628
    Google Scholar
  • 16 Kulcu E, Tamada JA, Reach G et al. Physiological Differences between Interstitial Glucose and Blood Glucose Measured in Human Subjects. Diabetes Care 2003; 26: 405-2409
    Google Scholar
  • 17 Wolpert HA. The nuts and bolts of achieving end points with real-time continuous glucose monitoring. Diabetes Care 2008; 31 (Suppl. 02)
    Google Scholar
  • 18 Mazze RS, Strock E, Stout P et al. A novel methodology to evaluate continuous glucose monitoring accuracy and clinical representation of glucose exposure and variability. Diabetes 2007; 56 (Suppl. 01)
    Google Scholar
  • 19 Kovatchev B, Heinemann L, Anderson S et al. Comparison of the numerical and clinical accuracy of four continuous glucose monitors. Diabetes Care 2008; 31: 1160-1164
    CrossrefGoogle Scholar
  • 20 Luijf YM, Mader JK, Doll W et al. AP@home consortium. Accuracy and Reliability of Continuous Glucose Monitoring Systems: A Head-to-Head Comparison. Diabetes Technol Ther 2013; 15: 721-726
    CrossrefGoogle Scholar
  • 21 Damiano ER, El-Khatib FH, Zhemg H et al. A Comparative Effectiveness Analysis of Three Continuous Glucose Monitors. Diabetes 2013; 62 (Suppl. 01)
    Google Scholar
  • 22 Koschinski T, Heckermann S, Heinemann L. Continuous Glucose Monitoring Allows for larger Measurement Errors than for SMBG: A New Application of the Diabetes Error Test Model. Diabetes 2007; 56 (Suppl. 01)
    Google Scholar
  • 23 Liebl A, Henrichs HR, Heinemann L et al. Arbeitsgruppe CGM der Arbeitsgemeinschaft Diabetologische Technologie der DDG (AGDT). Kontinuierliches Glukosemonitoring (CGM): Evidenz und Konsens für den klinischen Einsatz von CGM. Diabetes, Stoffwechsel und Herz 2012; 21: 32-47
    Google Scholar