Messsysteme für das kontinuierliche Glukosemonitoring – Vergleich der verschiedenen Systeme

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

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