New England Journal of Medicine (Impact Factor: 55.87). 10/2013; 369(15):1474-5. DOI: 10.1056/NEJMc1311059
Article: Beta-Zell-Ersatztherapie[Show abstract] [Hide abstract]
ABSTRACT: Background In patients with type 1 diabetes, glycemic values above the physiological range are associated with the development of long-term micro- and macrovascular complications. Thus, it is understandable that current guidelines for the majority of patients recommend glycemic values as close to the nondiabetic range as possible, as long as these can be attained without a relevant increase in hypoglycemia, or at least with the exclusion of severe hypoglycemia. Such a goal is a great challenge for patients, supervising diabetologists and diabetes educators. Despite various improvements in therapeutic options during the last few decades, the number of patients who reach the therapeutic goals is still not high enough. Current status Fortunately, new developments in recent years, especially in the field of diabetes technology, enable more patients to reach these recommended glycemic targets. A relevant contributing factor is the increasing use of more reliable continuous glucose monitoring systems (CGMS). Coupled with an insulin pump, the CGMS offers more stable (variability), better (HbA1c), and safer (hypoglycemia) glycemic control. In fact, the market penetration of these systems in Germany is still only in the single digit percentage range and therefore represents a remarkable, hitherto untapped potential. Recent models of this so-called “sensor augmented pump” (SAP) therapy are already using algorithms to temporarily stop insulin supply (predictive low glucose suspend) to avoid imminent hypoglycemia. Conclusion The next logical step is to fully automate insulin management in the sense of an artificial pancreas (AP), i.e., to establish a cycle of glucose monitoring and insulin delivery, a so-called “closed loop” system (CL). In the last 2 years significant progress has been made; several research groups are working on the establishment of commercially available systems. This work is based on the experience in the treatment of a comprehensive type 1 patient population and a selective literature search in PubMed for closed-loop systems with type 1 diabetes mellitus.
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