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Diabetologie und Stoffwechsel 2020; 15(06): 477-486
DOI: 10.1055/a-1259-1190
Originalarbeit

Insulinpumpe, kontinuierliche und kapilläre Glukosemessung bei Kindern, Jugendlichen und Erwachsenen mit Diabetes mellitus: Daten des DPV-Registers zwischen 1995 und 2019

Insulin pump, continuous and capillary glucose monitoring in children, adolescents and adults with diabetes mellitus: DPV registry data between 1995–2019
Hanna Schöttler
1   Diabetologische Ambulanz, Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt
,
Marie Auzanneau
2   Deutsches Zentrum für Diabetesforschung e. V. (DZD), München-Neuherberg
12   Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Ulm
,
Frank Best
3   Diabetologische Schwerpunktpraxis Best, Essen
,
Katarina Braune
4   Klinik für Pädiatrie m. S. Endokrinologie und Diabetologie, Charité Universitätsmedizin Berlin
,
Markus Freff
1   Diabetologische Ambulanz, Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt
,
Bettina Heidtmann
5   Pädiatrische Diabetologie und Endokrinologie, Katholisches Kinderkrankenhaus Wilhelmstift gGmbH, Hamburg
,
Ralf Jung
6   Abteilung Endokrinologie und Diabetologie, Krankenhaus Sachsenhausen, Frankfurt
,
Beate Karges
7   Sektion Endokrinologie und Diabetologie, RWTH, Aachen
,
Daniela Klee
8   Diabetologische Schwerpunktpraxis, Bürstadt
,
Antonia Müller
9   Klinik für Diabetes und Stoffwechselerkrankungen, Klinikum Karlsburg
,
Ulrike Schierloh
10   Abteilung für pädiatrische Endokrinologie und Diabetologie, Centre Hospitalier de Luxembourg
,
Christian Vogel
11   Abteilung pädiatrische Endokrinologie und Diabetologie, Klinikum Chemnitz gGmbH, Chemnitz
,
Reinhard W. Holl
2   Deutsches Zentrum für Diabetesforschung e. V. (DZD), München-Neuherberg
12   Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Ulm
› Author AffiliationsSupported by: Deutsche Zentrum für Diabetesforschung (DZD) 82DZD14A02/82DZD0039G
Supported by: Deutsche Diabetes Gesellschaft (DDG)
Supported by: Robert-Koch-Institut (RKI)
Supported by: Europäische Konsortium D4Kids (Profil/Diabeloop)
› Further Information
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Zusammenfassung

Ziel dieser Beobachtungsstudie ist die Beschreibung der aktuellen Nutzung von Diabetestechnologien bei Patienten/-innen mit Diabetes mellitus.

Methode Auswertung von Daten des DPV-Registers zur Nutzung der Insulinpumpentherapie (CSII), kontinuierlicher Glukosemessung (CGM) und der Selbstmessung der Blutglukose (SMBG) aus 497 teilnehmenden Zentren in Deutschland, Österreich, Luxemburg und der Schweiz zwischen 1995 und 2019. Die Daten wurden bei Patienten/-innen mit Diabetes Typ 1 (Alter ≥ 0,5 Jahre) für 5 Altersgruppen ausgewertet. Zusätzlich wurden aktuelle (zwischen 2017 und 2019) Geschlechtsunterschiede in der Verwendung von Diabetestechnologie bei Typ-1-Patienten/-innen untersucht, ebenso wie die Nutzung von Insulinpumpen und CGM für Patienten/-innen mit Insulintherapie bei Typ-2-DM, bei zystischer Fibrose (CFRD), bei anderen Pankreaserkrankungen, neonatalem Diabetes und Maturity Onset Diabetes of the Young (MODY).

Ergebnisse Es zeigte sich bei Patienten/-innen mit Diabetes Typ 1 ein Anstieg der CSII-Nutzung von 1995 bis 2019 von 1 % auf 55 % (2019: < 6 Jahre: 89 %; 6–< 12 Jahre: 67 %; 12–< 18 Jahre: 52 %; 18–< 25 Jahre: 48 %; ≥ 25 Jahre: 34 %). Die CGM-Nutzung erhöhte sich ab 2016 bis 2019 von 9 % auf 56 % (2019: 67 %; 68 %; 61 %; 47 %; 19 % der jeweiligen Altersgruppe). Die SMBG nahmen von 1995 bis 2015 insbesondere in den jüngeren Altersgruppen zu, gefolgt von einem Rückgang seit dem Jahr 2016 (Alle Patienten: 1995: 3,3/Tag; 2016: 5,4/Tag; 2019: 3,8/Tag). Weibliche Patienten mit Typ-1-Diabetes führten häufiger eine CSII und mehr SMBG als männliche Patienten durch (56 %/48 %, jeweils p-Wert: < 0,0001), während sich bei der CGM-Nutzung keine signifikanten Unterschiede zeigten.

Zwischen 2017 und 2019 erfolgte eine Nutzung von Insulinpumpen und CGM bei neonatalem Diabetes (CSII 87 %; CGM 38 %), bei MODY (CSII 14 %; CGM 28 %) und bei CFRD (CSII 18 %; CGM 22 %). CGM und CSII wurden dagegen nur selten von Menschen mit Insulintherapie und Diabetes Typ 2 (CSII < 1 %; CGM 1 %) und bei anderen Pankreaserkrankungen (CSII 3 %; CGM 4 %) genutzt.

Schlussfolgerung Moderne Diabetestechnologien werden derzeit insbesondere von pädiatrischen Patienten/-innen mit Diabetes Typ 1, aber auch von Menschen mit neonatalem Diabetes breit genutzt, von Patienten/-innen mit MODY und CFRD sowie Erwachsenen mit Diabetes Typ 1 in etwas geringerem Maße mit ansteigendem Trend. Dagegen sind diese Technologien in der Therapie des Typ-2-Diabetes und bei anderen Pankreaserkrankungen zurzeit nur wenig verbreitet.

Abstract

The aim of this observational study is to describe the current use of diabetes technology in patients with diabetes mellitus.

Method The use of insulin pump therapy (CSII), continuous glucose monitoring (CGM) and self-measurement of blood glucose (SMBG) was evaluated in patients with type 1 diabetes (age ≥ 0.5 years) between 1995 and 2019 for 5 age groups and for gender differences from 2017 to 2019 from 497 centers in Germany, Austria, Luxembourg and Switzerland participating in the diabetes registry “Diabetes Prospective Follow-up” (DPV). In addition, between 2017 and 2019, the use of insulin pumps and CGM for diabetes patients with insulin therapy in type 2 diabetes, cystic fibrosis (CFRD), other pancreatic diseases, neonatal diabetes and Maturity Onset Diabetes of the Young (MODY) were examined.

Results There was a strong increase in CSII from 1995 to 2019 in patients with type 1 diabetes from 1 % to 55 % (2019: < 6 years: 89 %; 6–< 12 years: 67 %; 12–< 18 years: 52 %; 18–< 25 years: 48 %; > 25 years: 34 %) and CGM use from 2016 to 2019 from 9 % to 56 % (2019: 67 %; 68 %; 61 %; 47 %; 19 % of respective age-groups). SMBG also increased in patients with type 1 diabetes between 1995 and 2015, especially in the younger age groups, but since 2016 a decrease has been observed for SMBG frequency (all patients: 1995: 3,3/day; 2016: 5,4/day; 2019: 3,8/day).

Between 2017 and 2019 there was a frequent use of pump and CGM in patients with neonatal diabetes (CSII 87 %/CGM 38 %), MODY (CSII 14 %/CGM 28 %) and CFRD (CSII 18 %/CGM 22 %). In contrast, CSII and CGM were rarely used by patients with type 2 diabetes (CSII < 1 %/CGM 1 %) and with diabetes due to other pancreatic diseases (CSII 3 %/CGM 4 %). Female patients with type 1 diabetes performed CSII more frequently than male patients (56 %/48 %, p-value: < 0.0001), while CGM use showed no gender differences.

Conclusion Modern diabetes technologies are widely used by pediatric type 1 diabetes patients, but also by patients with neonatal diabetes in recent years. Patients with MODY and CFRD as well as adult patients with type 1 diabetes used these technologies to a slightly lesser extent. In contrast, these technologies are currently rarely used in the treatment of patients of all age-groups with type 2 diabetes and patients with diabetes due to other pancreatic diseases.

Schlüsselwörter

Insulinpumpe - Kontinuierliche Glukosemessung - Diabetes mellitus - CGM - CSII

Key words

insulin pump - continuous glucose monitoring - diabetes mellitus - CGM - CSII


Publication History

Received: 21 June 2020

Accepted: 07 September 2020

Article published online:
09 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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