Aktuelle Aspekte der Insulinpumpentherapie bei Erwachsenen

In type 1 diabetes achieving a close to normal HbA1c level is a key target to avoid micro- and macro-vascular complications. However, close to normal HbA1c levels increase the risk of hypoglycemia and severe hypoglycemia considerably. With continuous subcutaneous insulin infusion (CSII) compared to the intensified conventional therapy (ICT) even lower HbA1c levels are achievable with an additional decreased blood glucose variability, e.g. less hypo- und hyperglycemic events. In addition to the improvement in glycemic control and variability, other typical indications include an increased rate of (nocturnal) hypoglycemia, hypoglycemia unawareness, the“dawn-phenomenon”, (planned) pregnancy, work-related reasons like shift work, high insulin sensitivity and various diabetes-related organ complications. At our center more than one third of patients with type 1 diabetes seen as in- or outpatients are currently on CSII. Across centers, different“recipes” exist to tailor an ideal CSII therapy for the individual patient; nevertheless, typical features for adult patients are discussed in this review. Special focus is put on the basal rate, bolus options, patient selection, education/training, technical capabilities of the currently available pumps and catheters and the choice of insulin.