Einführung: Pumpensurvey - IDF - Europäische Region

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Pumpensurvey 2006
IDF-Europäische Region
Symposium Diabetes-Technologie
2007
42 Jahrestagung der DDG
Hamburg 17.5.2007
HR HENRICHS

Slama, Hautecouverture, Assan,
Tschobroutsky 1974
•7 type 1 diabetic patients
•Regular insulin IV for 1-5 days
from peristaltic pump in
shoulder bag
•Basal rate and 15 fold higher
prandial rate
•Prolonged insulin infusions
feasible
•Very good glycaemic control
possible without closing the
loop but IV route has problems

ein langer Weg
„Five years ago it was expected that the insulin pump
would replace nearly all other traditional forms of
insulin treatment“
Kirsten Staehr Johansen
Chief, Quality of Care and Technologies, The Regional Office for Europe,
World Health Organization, Copenhagen, Denmark
St Vincent 10-12.Octobre 1989
Giornale italiano die Diabetologia 10 (Suppl) 55-61,1990

Treatment of Type 1 Diabetes (USA)

21. Century
„as a result of the widespread acceptance and
usefulness of CSII, it will eventually be used by
more than 40% of people with type 1 diabetes.
In addition, expanded Medicare coverage will
increase insulin pump use with type 2 diabetes.“
Bode BW, Tamborlane WV, Davidson PC:
Insulin pump therapy in the 21st century – Strategies for successful use in adults,
adolecents, and children with diabetes
Postgraduate Medicine online 111, 5;2002

Estimating the appropriate use of CSII*
•Frequent severe hypoglycaemia on MDI 5%
•hypoglycaemia disrupting daily life 9%
•HbA1c >9 or 9.5% on MDI 15%
•Dawn phenomenon on MDI <5%
•ca 25% not suitable or willing for CSII (decline CSII/prefer
MDI, psychologically unsuitable)
15-20% T1DM= CSII-
candidates
* J Pickup 2006

Pump penetration according to manufacturers data
4%
2%
2%
1%
2%
5%
16%
1%
19%
2%
4%
13%
7%
2%
2%
2%
10%
8%
4%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Pump penetration

„Access to CSII“
IDF-E – questionaire 10,2006

answers came from
•Azerbaijan A
•Belgium B
•Croatia CR
•Cyprus CY
•Finland FI
•France FR
•Georgia GEO
•Germany GE
•Hungary H
•Latvia LA
•Lithuania LI
•Macedonia M
•Norway N
•Poland POL
•Portugal POR
•Romania (2) R
•Serbia SER
•Slovakia SLA
•Slovenia SLE
•Spain SP
•Sweden SW
•Turkey T
•Ukraine UR
•United Kingdom UK
•Uzbekistan UZ

25 member (out of 59 IDF-E members)
countries
total population of
537 267 733

pumps available
y n
24 1

pumps
„at work“
Azerbaijan 2Poland 3 000
Belgium 1 000 Portugal 40
Croatia ca. 80 Romania 110
Cyprus 0Serbia 250
Finland ca. 900 Slovakia 680
France 10 000 Slovenia 695
Georgia 0Spain 1 000-1 200
Germany ~40 000 Sweden
Hungary 930 Turkey 1 000
Latvia 60 Ukraine 30
Lithuania 150 UK unclear wym
Macedonia 8Uzbekistan 0
Norway 3 000

pumps available since (y)
1975
1980
1985
1990
1995
2000
2005
2010
Y
A B Cy Fi FR G H I
La Li Ma N Pol Por R Se
Slova Slove Sp Sw T U UK Uz

% CSII of T1 DM
3
2,5
5
20
3,1
5
1
12
0,05
0,2
0,6
1,8
6
0,5
15
1,5
0
5
10
15
20
25
A B Cy Fi FR G H I La Li Ma N
Pol Por R Se Slova Slove Sp Sw T U UK Uz

estimated
%-
development
2006(100%) - 2010
B140
CR 600
CY 100
FI 200
GEO 500
GER 120
La 150
MA 1500
N 115
PO 220
R240 (600)
SLOVA 200
SLOVE 140
SP 200
T250

re-imbursement
Y n
13 6
Y/N once only pregnancy (8),
children (6)

indication „ranking“ (17 members)
indication nomination
position „1“
severe hypos 8
high HbA1c 4
pregnancy 3
childhood 2
flexibility 0
QoL 0

Pump penetration according to manufacturers data
4%
2%
2%
1%
2%
5%
16%
1%
19%
2%
4%
13%
7%
2%
2%
2%
10%
8%
4%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Pump penetration
K Zakrzewska,2006

Pumpen-Register Czech Republic
•1998 ff
•52 kooperierende Zentren, 18 CSII-Zentren
•2123 Patienten mit fortlaufender CSII
•245 terminierte CSII
•T1DM 87,7%, T2DM 7,3%, andere 5%
•ca. 4% aller T1DM

CSII 2006 - Schlußfolgerung (1)
•CSII ist technisch (aus-)gereift
•CSII Verbreitung in Europa ist rasch
wachsend aber (noch)
•sehr unterschiedlich von Land zu Land
•das CSII-Interesse wächst bei Pat. und
Betreuern