Continuous Glucose Monitoring (CGM) and Sensor-Augmented Pump Therapy (SAP): UNI-MED SCIENCE

1. State of the art in the technical development of modern insulin pumps 10 1.1. Historical development of insulin pumps 10 1.2. Change in the indications for CSII 12 1.3. Characteristics and functionality of modern insulin pumps 13 1.3.1. Currently available insulin pumps 13 1.3.2. The "treasures of insulin pump therapy" 13 1.3.2.1. Overview 13 1.3.2.2. "CSII treasure number 1": multibasal rate administration 16 1.3.2.3. "CSII treasure number 2": different bolus options 17 1.3.2.4. "CSII treasure number 3": bolus calculator 17 1.3.3. Differences in the functions of modern insulin pumps 18 1.3.4. Use of the standard function of modern insulin pumps 19 1.3.5. Association of CSII and CGM for SAP 20 1.3.6. "Patch pumps" - insulin pumps without catheters 21 1.3.7. Implanted insulin pumps 22 1.4. Summary 23 1.5. References 23 2. Technical developments in the field of continuous glucose monitoring 26 2.1. Principles of the detection of glucose in blood or in interstitial fluid 26 2.2. Basic possibilities for continuous glucose monitoring (CGM) 28 2.2.1. Overview 28 2.2.2. Glucose monitoring in interstitial fluid with minimally invasive sensors 29 2.2.3. Glucose monitoring with implantable glucose sensors 30 2.2.4. Glucose monitoring with non-invasive glucose sensors 31 2.3. Properties and comparison of the available systems of the needle sensor type 33 2.4. References 38 3. Characteristics of continuous glucose monitoring (CGM) 42 3.1. Methods of CGM 42 3.1.1. Distinction between diagnostic and therapeutic use 42 3.1.2. Diagnostic application of CGM 42 3.1.3. Use of CGM in everyday treatment control 44 3.2. Differences in CGM in relation to self-monitoring of blood glucose (SMBG) 46 3.2.1. Uninterrupted measurement and visualisation of the dynamic glucose profile as a result of CGM 46 3.2.2. Consequences of CGM measurement in interstitial fluid 46 3.2.3. Calibration of CGM 47 3.2.4. Setting of alarms and pre-alarms 49 3.3. Utilisation of software for the display, analysis and evaluation of CGM measurements 50 3.3.1. Overview 50 3.3.2. Displays in CareLink(TM) software 51 3.3.2.1. CareLink(TM) PERSONAL 51 3.3.2.2. CareLink(TM) PRO 52 3.3.2.3. CareLink(TM) iPro(TM) 55 3.3.3. Summary 56 3.4. References 56 4. Aspects of the combination of glucose sensor and insulin pump 62 4.1. Potential of the combination of insulin pump and sensor 62 4.2. Support of CGM when starting a patient on insulin pump therapy 62 4.3. Utilisation of CGM profiles for training pump wearers 63 4.4. Influence of CGM on the full exploitation of the extended functions of modern insulin pumps 64 4.5. CGM as proof of successful pump initiation for the medical insurance companies 65 4.6. Sensor-augmented pump therapy (SAP) 66 4.7. Interconnection of glucose sensor and insulin pump for the closed loop system 69 4.8. References 72 5. Problem analysis from glucose profiles recorded with CGM 76 5.1. Overview 76 5.2. The magic of blood glucose and what interstitial glucose tells us about it 76 5.3. Hypoglycaemic episodes 77 5.3.1. Forensics with an evolutionary biological background 77 5.3.2. Classification of hypoglycaemia based on its symptoms 78 5.3.3. Clinical pathology of compromised counter-regulation 79 5.4. Use of CGM for the analysis of the glucose profile and detection of hypoglycaemia 79 5.5. Characteristic details in the CGM profiles 81 5.6. "Criminology" of the glucose level 83 5.6.1. Fine analysis of glucose profiles by "forensic detective work" 83 5.6.2. Criminology of nocturnal hypoglycaemia and its consequences 84 5.6.2.1. Possible motive and opportunity 84 5.6.2.2. From clues to the profile of the offender 84 5.6.2.3. Catching red-handed 85 5.6.2.4. Scene of the crime and search for tracks (standard pattern) 86 5.6.2.5. Disguises and deception 87 5.6.2.6. The usual suspects 89 5.6.2.7. Key points for "criminology" 89 5.6.3. Example of a patient 90 5.7. References 93 6. Getting started on sensor-augmented pump therapy 96 6.1. Overview 96 6.2. Insulin selection 96 6.3. Insulin dosage 97 6.3.1. Daily insulin requirement and its division 97 6.3.2. Basal rate 98 6.3.2.1. Determination of the basal rate 98 6.3.2.2. Checking the basal rate 98 6.3.2.3. Use of various basal rate profiles 98 6.3.2.4. Temporary basal rate 99 6.4. Bolus delivery 99 6.4.1. Bolus management 99 6.4.2. Bolus options 100 6.4.3. Correction/bolus calculator, BolusWizard® 102 6.5. References 104 7. Clinical evidence on CSII, CGM and SAP 108 7.1. Evidence-based medicine (EBM): how far can this be demanded for CSII, CGM and SAP? 108 7.2. Clinical evidence on insulin pump therapy CSII 110 7.2.1. Overview 110 7.2.2. Experimental and clinical results of CSII in patients with type 1 diabetes 110 7.2.3. Experimental and clinical results for CSII in patients with type 2 diabetes 116 7.2.4. Meta-analyses on CSII 117 7.3. Clinical evidence for continuous glucose monitoring (CGM) 119 7.4. Experimental and clinical evidence for sensor-augmented pump therapy (SAP) 123 7.5. References 127 8. Is continuous glucose monitoring leading to a paradigm shift in diabetology? 134 8.1. Empirical diabetology 134 8.2. Diabetology based on data 135 8.2.1. HbA1c and glucose excursions 135 8.2.2. The glucose pentagon model 136 8.3. Diabetology based on data in everyday practice 138 8.4. Summary 139 8.5. References 140 Index 142