Das kontinuierliche Glukosemonitoring (CGM) hat sich zu einer praxistauglichen Technologie
entwickelt, die im Begriff ist, gegenwärtige Konzepte der Glykämiekontrolle und des
Diabetesmanagements zu revolutionieren. Im Gegensatz zur traditionellen Glykämiekontrolle
mit dem Glukometer, kann das CGM Glukoseprofile darstellen, Echtzeit–Werte angeben,
Informationen über die Dynamik der Glukoseveränderungen liefern sowie vor Hypo– oder
Hyperglykämien warnen. Die bisherigen Outcomes zeigten aber, dass für die optimale
Anwendung und Auswertung erhaltener Daten in der Praxis Leitlinien notwendig sind.
Die Vorteile zugelassener CGM–Systeme, klinische Indikationen, Erfahrungen beim Einsatz
in der Diabetestherapie und Probleme bei der Datenauswertung werden in der folgenden
Übersicht dargelegt.
Continuous glucose monitoring (CGM) technology made tremendous progress and has now
started to impact current concepts in glycemic control and management of diabetes.
While traditional glucose meters reveal a glucose value at a single time point that
is determined by the user, CGM provides patients and their health care providers with
glucose profiles and real–time values, information about the dynamics of glucose changes
and alerts them to hypo– as well hyperglycemia. The high potential of this technology
to optimize diabetes control has convincingly been demonstrated. However, the outcomes
have also shown that for routine diabetes control practice guidelines are required
for optimal use and appropriate data analysis in order to use the full potential of
CGM for the benefit of the diabetic patients. This report primarily discusses advantages
of currently approved needle–sensor CGM systems, clinical indications for their use,
outcomes, and problems in data analysis.
Key words
Continuous glucose monitoring technology - self–monitoring blood glucose - glycemic
control - clinical outcomes - data analysis
Literatur
- 1 Hamann O, Herrmann M, Messer R.. Die kontinuierliche Glukosemessung als ergänzendes
diagnostisches Untersuchungsverfahren zur Optimierung des Glukosestoffwechsels bei
Diabetikern. Stuttgart und Berlin: WiKu–Verlag–Verlag für Wissenschaft und Kultur
2003: 1-165
- 2
Hirsch IB, Armstrong D, Bergenstal RM. et al. .
Clinical Application of Emerging Sensor Technologies in Diabetes Management: consensus
guidelines for continuous glucose monitoring (CGM).
Diabetes Technol Ther.
2008;
10
232-246
- 3
Klonoff DC..
Continuous Glucose Monitoring: roadmap for the 21th century diabetes therapy.
Diabetes Care.
2005;
28
1231-1239
- 4
Kovatchev BP, Shields D, Breton M..
Graphical and Numerical Evaluation of Continuous Glucose Sensing Time Lag.
Diabetes Technol Ther.
2009;
11
139-143
- 5
Bailey TS, Zisser HC, Garg SK..
Reduction in Hemoglobin A1c with Real–Time Continuous Glucose Monitoring: Results
from a 12–week observational study.
Diabetes Technol Ther.
2004;
6
518-522
- 6
Kohnert KD, Vogt L, Augstein P. et al. .
Relationships between Glucose Variability and Conventional Measures of Glycemic Control
in Continuously Monitored Patients with Type 2 Diabetes.
Horm Metab Res.
2009;
41
137-141
- 7
McGarraugh G, Bergenstal R..
Detection of Hypoglycemia with Continuous Interstitial and Traditional Blood Glucose
Monitoring Using the FreeStyle Navigator Continuous Glucose Monitoring System.
Diabetes Technol Ther.
2009;
11
145-150
- 8
Salzsieder E, Augstein P, Vogt L. et al. .
Telemedicine–based KADIS® Combined with CGMS™ has High Potential for Improving Outpatient
Diabetes Care.
J Diabetes Sci Technol.
2007;
1
511-521
- 9
Salzsieder E..
Expertensysteme im Rahmen von Verträgen zur integrierten Versorgung.
IGV–Symposium der TANUS BKK, Berlin.
19;
3
2009
- 10
Monnier L, Colette C, Owens DR..
Glycemic Variability: The third Component of the Dysglycemia in Diabetes. Is It important?
How to Measure It?.
J Diabetes Sci Technol.
2008;
2
1094-1100
- 11
Thomas A..
Kontinuierliches Monitoring: Neue Säule der Diagnostik und Therapie?.
Diabetes Congress Report.
2008;
4
6-11
Korrespondenz
PD Dr. Dr. Klaus–Dieter Kohnert
Institut für Diabetes „Gerhardt Katsch Karlsburg”
Greifswalder Str. 11e
17495 Karlsburg
Email: kohnert@diabetes-karlsburg.de