Wie häufig nutzen Patienten mit einer Insulinpumpentherapie (CSII) die Features Ihrer Insulinpumpe?

Fragestellung: Die Insulinpumpentherapie (CSII) bietet mehrere Zusatzoptionen, um die Blutglukose im Alltag besser steuern zu können. Hierzu zählen eine temporäre Basalrate, unterschiedliche Basalratenprofile und Bolusoptionen sowie die Nutzung von Boluskalkulatoren, Softwareprogrammen zur Analyse von Glukosedaten und eine kontinuierliche Glukosemessung. In dieser Studie wurde untersucht wie häufig langjährige CSII-Träger solche Zusatzoptionen im Alltag nutzen. Methodik: Die Stichprobe umfasst 278 Typ-1-Diabetiker (Teilnehmer der INPUT-Studie) mit CSII-Therapie (Alter 43,7±14,3 Jahre; 59,9 % weiblich; DD 23,0 ±12,4 Jahre; HbA1c 8,4±0,9% bzw. 68±9,8 mmol/mol; Dauer CSII-Therapie 9,6±7,4 Jahre). Die Häufigkeit der Nutzung von Zusatz-Features für die CSII-Therapie wurde mittels Fragebogen erhoben. Ergebnisse: 67,9% der INPUT-Studienteilnehmer geben an, regelmäßig (d.h. mehrmals pro Woche oder täglich) einen Boluskalkulator zu benutzen. Verschiedenen Bolusoptionen werden regelmäßig von 38,4% genutzt, temporäre Basalraten von 31% der Befragten. Unterschiedliche Basalratenprofile werden dagegen nur von 8,5% der CSII-Träger regelmäßig eingesetzt. Nur wenige der Befragten nutzen eine kontinuierliche Glukosemessung (6,8%) oder die technische Möglichkeit Glukosedaten auszulesen und zu analysieren (5,6%). In einer schrittweisen Regressionsanalyse war jedoch die Häufigkeit der software-gestützten Analyse von Glukosedaten mit einem signifikante niedrigeren HbA1c (ß=-0,15, p=0,012) assoziiert. Schlussfolgerung: Obwohl die CSII-Therapie die aufwändigste Form der Insulintherapie darstellt, bleibt die glykämische Kontrolle häufig suboptimal. Die technischen Möglichkeiten einer Insulinpumpentherapie - mit Ausnahme der Nutzung von Boluskalkulatoren - werden von der Mehrzahl der langjährigen CSII-Träger nicht regelmäßig genutzt. Es sollte daher geprüft werden, ob mit Hilfe von speziellen Schulungsmaßnahmen zur Insulinpumpentherapie eine bessere Nutzung der technischen Möglichkeiten dieser Therapieform und damit einhergehend auch eine bessere Therapieeffizienz erreicht werden kann

Use of technological Features of Insulin Pump as Predictors of Glycaemic Control in Patients with CSII Therapy

Technological features of CSII therapy comprise temporal basal rates, different basal rate profiles, use of bolus calculators, and bolus variants. In addition, real-time CGM data as well as computerized analysis of glucose data can be used to adjust insulin pump therapy. In this study, the associations between the frequency of use of these technological features and glycaemic control were analysed

Wie effektiv ist die strukturierte Diabetesschulung bei Menschen mit Typ-1-Diabetes und Insulinpumpentherapie (CSII)?

In dieser Studie wurde untersucht, ob sich Menschen mit Typ-1-Diabetes und Insulinpumpentherapie (CSII), die einen erhöhten HbA1c-Wert, eine Hyperglykämie- oder Hypoglykämie-Problematik im letzten Jahr, oder einen erhöhten Diabetes-Distress aufwiesen, hinsichtlich der Anzahl der bisherigen Schulungen von Personen ohne diese jeweilige Problematik unterscheiden

Makes FLASH the difference between the intervention group and the treatment-as-usual group in an evaluation study of a structured education and treatment programme for flash glucose monitoring devices in people with diabetes on intensive insulin therapy: study protocol for a randomised controlled trial

Abstract Background People with diabetes on intensive insulin therapy need sufficient glycaemic control to prevent the onset or progression of diabetic complications. The burden of multiple daily blood glucose self-testing can be lessened by novel diabetes technology like flash glucose monitoring systems which provide more information compared to self-monitoring of blood glucose. Despite this delivered additional information studies are showing no significant effect on HbA1c reduction, but a reduced time spent in a hypoglycaemic glucose range. We assume that users of these devices need additional education and training to integrate the delivered information into treatment decisions. Therefore, FLASH, an education and treatment programme, was developed. The programme evaluation follows herein. Methods/design Patients are recruited through 40 diabetes outpatient study centres located across Germany. They will be randomly assigned to participate in the education and treatment programme (intervention group) or to obtain treatment as usual (control group). All patients have to give blood samples and to answer a bench of questionnaires during baseline assessment, at the end of the intervention, and 6 months after the end of the intervention. Physicians will be asked to declare some additional clinical data (such as details of the diabetes therapy) for every patient at every one of the three assessment points. Discussion This study is conducted as a randomised controlled trial to test the hypothesis that the newly developed education and treatment programme combined with the use of a flash glucose monitoring device (intervention group) is superior to reduce HbA1c compared to the use of flash glucose monitoring alone (control group). The first results will be expected in 2018. Trial registration ClinicalTrials.gov, ID: NCT03175315. Registered on 2 May 2017

Wie misst man Erfahrungen und Einstellungen zur Insulinpumpentherapie: Eine psychometrische Analyse des Fragebogens zu Erfahrungen und Einstellungen zur CSII-Therapie (CSII-EE)

Die Ergebnisse der Insulinpumpentherapie (CSII) bleiben hinter ihren Möglichkeiten zurück. Eine potentielle Ursache hierfür können subjektive Erfahrungen und Einstellungen der Anwender sein. In dieser Evaluationsstudie wurden die psychometrischen Eigenschaften eines Fragebogens zur Erfassung von „Erfahrungen und Einstellungen zur Insulinpumpentherapie“ (CSII-EE) untersucht

How effective is structured diabetes education in people with diabetes and CSII-treatment?

We analyzed the impact of structured diabetes education on clinical problems in people with diabetes and CSII-therapy. In this analysis, baseline data of 278 people with diabetes and CSII-therapy were included (age 43.7 ± 14.3 yrs., diabetes duration 23.0 ± 12.4 yrs., HbA1c 8.3 ± 0.9%; duration of CSII-therapy 9.6 yrs. ± 7.3 yrs.; 4.4 ± 3.3 structured diabetes education courses) who participated in the INPUT study. From these 278 participants, 90% had an A1c higher than 7.5%, 12.6% reported the occurrence of ketoacidosis in the last year, 9% reported severe hypoglycemia during the last year, 50.5% reported elevated diabetes-related distress (DDS score > 2.0) and 10% reported low well-being which could be indicative for likely depression (WHO score < 28). The following table shows the number of previous structured diabetes education courses in people with and without clinical problems. Elevated HbA1c Ketoacidosis Hypoglycemia Diabetes Distress Likely depression No 3.3 ±2.1 4.4 ±3.3 4.4 ±3.4 3.9 ±2.7 4.3 ±3.2 Yes 4.5 ±3.4 4.4 ±3.8 4.2 ±3.3 4.8 ±3.8 5.2 ±4.2 p 0.016 0.917 0.750 0.024 0.230 People with elevated HbA1c and elevated diabetes distress were previously more likely referred to structured diabetes education. Participation in structured diabetes education was not different in people with acute complications like hypoglycemia or ketoacidosis. Current structured diabetes education programs may not be optimally suited for ameliorating clinical or psychosocial problems in people with diabetes and CSII Treatment. There might be a need for more CSII specific diabetes education programs

Change in the usage of pump features predicts improvement of glycemic control

Insulin pumps offer a wide range of technical features designed to help patients with achieving optimal glycemic control. However, many patients do not achieve better glycemic control despite CSII therapy. In this study, we analyzed whether a change in using pump features was associated with an improvement in glycemic control. 197 patients with CSII treatment were analyzed at baseline and 12-weeks later (age 42.2 ± 14.3 yrs.; 59% female; diabetes duration 22.2 ± 11.9 yrs.; duration of CSII 9.4 ± 7.3 yrs.; baseline A1c 8.3 ± 0.9%). Change in using pump features (see table) were the independent variables of interest in a linear regression analysis on the difference in HbA1c (follow-up – baseline). The analysis was controlled for demographic (age, gender, BMI, education) and medical variables (diabetes duration, duration of CSII, use of CGM/FGM, complications, SMBG). Increased use of pump features standardized beta p Temporary basal rates -0.16 .027 Different basal rate profiles -0.09 .219 Bolus options 0.16 .031 Bolus calculators 0.02 .790 Analysis software -0.16 .025 CGM pairing -0.23 .002 An increased use of temporary basal rates as well as using analysis software more often predicted an improvement in HbA1c (see table). Linking a CGM system to the insulin pump was the strongest predictor of better glycemic control. In clinical practice, patients with CSII therapy should be educated how to make use of their pump features and should be encouraged to do so

Efficacy of an Education Program for People With Diabetes and Insulin Pump Treatment (INPUT): Results From a Randomized Controlled Trial

OBJECTIVE Continuous subcutaneous insulin infusion (CSII) is the most advanced form of insulin delivery, but it requires structured education to provide users with the necessary knowledge/skills and to support their motivation. Currently, no structured education program designed to provide this training has been evaluated. We developed a CSII-specific, structured education program (Insulin Pump Treatment [INPUT]) and evaluated its impact on glycemic control, behavior, and psychosocial status. RESEARCH DESIGN AND METHODS This was a multicenter, randomized, parallel trial with a 6-month follow-up. Eligible participants (age 16–75 years) currently were treated with insulin pump therapy. Participants were randomly assigned (1:1) to the INPUT program or to usual care using a computer-generated algorithm, with study center as the stratification factor. The primary outcome was HbA1c change from baseline to 6 months. Secondary outcomes were incidence of severe hypoglycemia and changes in behavioral and psychosocial measures. RESULTS Between 1 April 2016 and 26 April 2016, 268 people with diabetes and a mean duration of CSII therapy of 9.5 years were randomly assigned to the INPUT group (n = 135) or control group (n = 133). At 6 months, HbA1c improved in the INPUT group (8.33 ± 0.8 vs. 8.04 ± 0.9; P < 0.0001) but not in the control group (8.33 ± 1.0 vs. 8.27 ± 1.0; P = 0.11). The between-group difference in HbA1c reduction was significant, favoring INPUT (−0.28% vs. −0.06%, Δ −0.22%, 95% CI −0.38 to −0.06; P = 0.0029). The incidence rate ratio of severe hypoglycemia was 3.55 times higher for participants in the control group than for those in the INPUT group (95% CI 1.50–8.43; P = 0.0041). CONCLUSIONS The INPUT education program led to a significant improvement in glycemic control and incidence of severe hypoglycemia in insulin pump users

Suboptimale Diabetesakzeptanz ist mit einer schlechteren Diabetes-Selbstbehandlung und darüber mit einer schlechteren glykämischen Kontrolle assoziiert: Eine Mediationsanalyse

Die klinische Bedeutung von Diabetesakzeptanz ist bisher nicht eindeutig geklärt. In dieser Studie wurde untersucht, in welcher Weise Diabetesakzeptanz mit Selbstbehandlungsverhalten und glykämischer Kontrolle assoziiert ist - unabhängig von Diabetesbelastung und Depressivität