Ergebnisse von Patienten aus der Ambulanz

 Ergebnisse von 8 Patienten, die für mindestens 6 Monate mit einer CGM gesteuerten Insulinpumpentherapie behandelt worden sind, wurden auf

einer Poster Präsentation von der Jahrestagung der Amerikanischen

Diabetesgesellschaft in Boston 2015 und auf dem

ATTD im Mailand 2016  von mir vorgestellt.

 

Es wurden die 8 Patienten mit einer CGM gesteuerten Insulinpumpentherapie über 6 Monate mit einer Zwischenkontrolle nach

3 Monaten analysiert.

Ergebnisse kurzgefasst:

 

CGM-Bereich

Prozentsatz der Zeit

70-180 mg/dl

77,9

>180 mg/dl

16,5

<70 mg/dl

5,6

<55 mg/dl

1,6

Mittlere Glukose mg/dl

131,1

SD

46,1

HbA1c-Wert vor

6,9 %

HbA1c-Wert nach:

12 Wochen

24 Wochen

 

6,41%

6,48%

 

Insulin pump therapy directed only  by  a continuous glucose monitoring system (CGM)

in Type 1 Diabetes in everyday life
Mueller-KorbschM.   5. Med. Department, Wilhelminenspital   Vienna/Austria 

Summary

8 Patients treated for their Diabetes Type 1 with insulin pump therapy were switched from the common finger stick glucose measurements to a continuous glucose monitoring system (CGM). Finger stick blood  glucose was taken once a day  during a steady state glucose level to calibrate the system .
The CGM values and the trends were used to calculate the prandial insulin doses and to correct higher glucose levels by the bolus calculator. In addition the patients  received an algorithm to respond to rising and falling trends shown on the CGM. If the CGM trends were rising, patients had to  receive a supplement insulin dose; if the trends were falling the insulin pump was stopped and sometimes additional carbohydrates had to be given.
The amount of hypoglycemic values <70mg/dl (3,1 mmol/l) was 5,6 %  of times and  52% of times the values lies in the target area with 70- 130 mg/dl (3,9- 7,3 mmo/l). The HbA1c decreased   about  0,1 to 1% from the basic values.
The mean glucose level over all is 131 mg/dl with a standard deviation of 46. The observation period for each patient is at least 6 months.
With this new way of routing  the insulin pump therapy by the CGM no unexpected glucose values appeared and if the values go up or down the patients have the possibility to optimize the ongoing process in a better way. Therefore it is not necessary to count the carbohydrates exactly.


Results

All the data over3 months period from each patients were analyzed at 2 fixed points of time with the Dexcom softwear.

In comparison our data to the control of the study:

Outpatient Glycemic Control witha Bionic Pancreas in Typ 1 Diabetes, (S.J. Russell and Other, The New England Journal of Medicine Vol. 371 No.4 S.313, July2014)         N= 20 over 5 days

Mean glucose levels: 159 mg/dl range (105-225 mg/dl)

                         values  < 70 mg/dl: 7,3% of times  (range:0-16 %)

Mean glucose levels in our study of all patients: 131 mg/dl range (93-176 mg/dl)

                         values  < 70 mg/dl: 5,6 % of times  (range:1-11%)

Conclusion

It is possible to drive an insulin pump therapy with a CGM system without multiple blood glucose measurments.

The HbA1c-values were decreased from about 0,1- 1 % from the beginning to the end of the observation.

If the patient gives additional insulin doses for glucose trends the mean glucose levels are lower in comparison to control group of closed loop study and there are no more hypoglycemic episodes.

With this new way of routing the insulin pump therapy by the CGM no unexpected glucose values appeared and if the values go up or down the patient has the possibility to change the ongoing process in more effective way. Therefore it is not necessary to count the carbohydrates exactly.