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Background: Recently two new tubeless pumps for insulin therapy were introduced. They were tested for accuracy and occlusion detection and compared with the established patch pump Omnipod® (OP). Methods: Using a modified setup for tubeless pumps based on IEC 60601-2-24, the basal rate and bolus delivery of the Accu-Chek® Solo micropump system (ACS) and the A6 TouchCare® System (A6) were measured with a microgravimetric method. Bolus sizes of 0.2, 1, and 10 U, and basal rates of 0.1 and 1 U/h were evaluated in nine repetitions. For each parameter, mean deviation and number of individual boluses or 1-h basal rate windows within ±15% from target were calculated. In addition, occlusion detection time at basal rates of 0.1 and 1 U/h was determined. Results: Mean deviation of boluses of different volumes in the pumps ranged from −3.3% to +4.0% and 40%–100% of individual boluses were within ±15% of the target. During basal rate delivery, 48% to 98% of 1-h windows were within ±15% of the target with a mean deviation between -5.3% and +6.5%. In general, considerable differences between pump models were observed and deviations decreased with increasing doses. In most parameters, ACS was more accurate, and A6 less accurate, than OP. Mean occlusion detection time ranged from ∼3 to 7.5 h at 1 U/h and was >24 h or absent at 0.1 U/h. Conclusions: In this evaluation, significant differences between the tested tubeless pump models were observed that became most evident when regarding delivery errors over short time and small volumes.

Objective: Patch pumps, i.e. tubeless insulin pumps, are an attractive alternative to conventional insulin pumps for people with type 1 diabetes and type 2 diabetes on insulin therapy. However, to date, the patient-related benefits of patch pumps are not well understood. Methods: A systematic review was conducted to summarize potential patient-relevant advantages and disadvantages of patch pumps and to assess relevant studies on patient-reported outcomes (PROs) . Relevant studies were identified by a systematic PubMed search. In addition, the reference lists of the respective articles and Google Scholar were checked for further references. English-language articles published before June 30, 2021, were included; no other publication date criteria were specified. Results: A total of 12 studies were included. The results of this analysis demonstrate that patch pumps improve quality of life, reduce diabetes-related symptoms, increase patient satisfaction, and are preferred by patients compared with conventional insulin pumps and daily multiple injection (MDI) therapy. However, several methodological limitations of the identified studies limit the power of this analysis. Conclusions: Despite the limited number of studies evaluating the benefits of patch pumps in relation to PROs, there is increasing evidence that people with diabetes prefer patch pumps compared to MDI and conventional pumps. It is notable that this aspect has been relatively understudied. More systematic studies evaluating the benefit of patch pumps in relation to PROs are needed. Disclosure B.Kulzer: Advisory Panel; Bayer AG, Bayer AG, Becton, Dickinson and Company, Becton, Dickinson and Company, Berlin-Chemie AG, Berlin-Chemie AG, Dexcom, Inc., Dexcom, Inc., Insulet Corporation, Novo Nordisk, Roche Diabetes Care, Sanofi, Sanofi-Aventis Deutschland GmbH, Research Support; Novo Nordisk, Roche Diabetes Care. G.Freckmann: Advisory Panel; Abbott Diabetes, Dexcom, Inc., Lilly, Roche Diabetes Care, Roche Diagnostics, Consultant; Ascensia Diabetes Care, Berlin-Chemie AG, Boydsens, Metronom, mySugr, Roche Diabetes Care, Sanofi-Aventis Deutschland GmbH, Research Support; Dexcom, Inc., Medtronic, Menarini Group, Roche Diabetes Care, Sanofi, Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc., Lilly, Novo Nordisk, Roche Diabetes Care, Terumo Corporation. L.Heinemann: Board Member; Lifecare, Inc., Consultant; Becton, Dickinson and Company, Roche Diabetes Care, Stock/Shareholder; Profil Institut für Stoffwechselforschung GmbH, Science Consulting in Diabetes GmbH. O.Schnell: Advisory Panel; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly, Roche Diabetes Care. R.Hinzmann: Employee; Roche Diabetes Care. R.Ziegler: Advisory Panel; Eli Lilly and Company, mySugr, Novo Nordisk, Roche Diabetes Care, Speaker's Bureau; A. Menarini Diagnostics, Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Glooko, Inc., Novo Nordisk, Roche Diabetes Care.

Continuous subcutaneous insulin infusion (CSII) therapy is becoming increasingly popular. CSII provides convenient insulin delivery, precise dosing, easy adjustments for physical activity, stress, or illness, and integration with continuous glucose monitors in hybrid or other closed-loop systems. However, even as insulin pump hardware and software have advanced, technology for insulin infusion sets (IISs) has stayed relatively stagnant over time and is often referred to as the “Achilles heel” of CSII. To discuss barriers to insulin pump therapy and present information about advancements in, and results from clinical trials of extended wear IISs, Diabetes Technology Society virtually hosted the “Improving the Patient Experience with Longer Wear Infusion Sets Symposium” on December 1, 2021. The symposium featured experts in the field of IISs, including representatives from Steno Diabetes Center Copenhagen, University of California San Francisco, Stanford University, Medtronic Diabetes, and Science Consulting in Diabetes. The webinar’s seven speakers covered (1) advancements in insulin pump therapy, (2) efficacy of longer wear infusion sets, and (3) innovations to reduce plastics and insulin waste.

Recent in vitro experiments with patch pumps (PP) Omnipod (OP), Omnipod DASH (OP-D), A6 TouchCare (A6), and Accu-Chek Solo (ACS) have observed periodic fluctuations in the delivered amount of insulin during basal rate and consecutive bolus delivery in some PP, calling for a more systematic characterization of these periodic delivery patterns. Here, it was found that during basal rate delivery of 1 U/h, some devices of OP, OP-D, and A6 showed deviations of up to ±30% from target delivery that consistently repeated every 5 hours, whereas ACS showed no clear periodicity with considerably lower deviations. Similar results were found during consecutive bolus delivery of 1 U, where deviations repeated consistently every five boluses in some devices of OP, OP-D, and A6. However, there was a large variability in the periodic delivery patterns between individual devices of the same PP model. Examining their pumping techniques indicated a connection between the insulin delivery mechanism and observed delivery patterns of the PP. However, the clinical impact of such patterns is unclear.

Background: The GoBolus study investigated the real-world effectiveness of faster aspart in patients with type 1 diabetes (T1D) using intermittent-scanning continuous glucose monitoring (iscCGM) systems. Methods: This 24-week, multicenter, single-arm, noninterventional study investigated adults with T1D (HbA1c, 7.5%–9.5%) receiving multiple daily injections (MDI) of insulin and using iscCGM within local healthcare settings for ≥6 months before switching to faster aspart at study start (week 0; baseline). Primary endpoint was HbA1c change from baseline to week 24. Exploratory endpoint was change in iscCGM metrics from baseline to week 24. Results: Overall, 243 patients were included (55.6% male), with mean age/diabetes duration, 49.9/18.8 years; mean HbA1c, 8.1%. By week 24, HbA1c had decreased by 0.19% (−2.1 mmol/mol, P 10.0 mmol/L, P = 0.026) and 20.4% to 17.9% (>13.9 mmol/L, P = 0.013), corresponding to 43.5 (P = 0.024) and 35.6 (P = 0.015) fewer minutes per day on average spent in these ranges, respectively; no change for time in hypoglycemia (

For decades, self-monitoring of blood glucose (SMBG) has been considered a cornerstone of adequate diabetes management. Structured SMBG can follow different monitoring patterns, and it results in improved glycemic control, reduced hypoglycemia, and a better quality of life of people with diabetes. The technology, usability, and accuracy of SMBG systems have advanced markedly since their introduction a few decades ago. Current SMBG systems are small and easy to use, require small (capillary) blood sample volumes, and provide measurement results within seconds. In addition, devices are increasingly equipped with features such as connectivity to other devices and/or digital diaries and diabetes management tools. Although measurement quality can come close to or equal that of the glucose monitoring systems used by healthcare professionals, several available SMBG systems still do not meet internationally accepted accuracy standards, such as the International Organization for Standardization 15197 standard. Reports from China, India, and Brazil based on local experience suggest that in addition of the accuracy issues of SMBG systems, other obstacles also need to be overcome to optimize SMBG usage. Nonetheless, adequate usage of SMBG data is of high relevance for the management of people with type 2 diabetes mellitus.

In addition to the continuous use, the intermittent use of continuous glucose monitoring (CGM) is an application of CGM, expanding the typical medical use cases. There are a variety of reasons and occasions that speak in favor of using CGM only for a limited time. To date, these circumstances have not been sufficiently discussed. In this article, we define discontinuous or intermittent CGM use, provide reasons for using it, and expand on the benefits and possibilities of using CGM on a temporary basis. We aim to draw attention to this important topic in the discussion of CGM use and give examples for a different method of CGM use. As well, we would like to foster the allocation of CGM to the right patient groups and indications, especially in cases of limited resources. From a global point of view, intermittent CGM use is more likely to occur than continuous use, primarily for economic reasons.

Patch pumps, i.e. insulin pumps without tubing, are an attractive alternative to conventional insulin pumps for people with type 1 diabetes and type 2 diabetes on insulin therapy. In this review, potential patient-relevant advantages and disadvantages of patch pumps are summarized and respective studies on patient-reported outcomes (PROs) are assessed.Relevant studies were identified through a systematic PubMed search. Reference lists in respective articles and Google Scholar were also checked for additional references. Articles in English published before June 30, 2021, were included; no other criteria on publication dates were set.A total of 12 studies were included. The results of this analysis provide evidence that patch pumps improve quality of life, reduce diabetes-related distress, increase patient satisfaction, and are preferred by patients compared to conventional insulin pumps and multiple daily injection therapy (MDI). However, several methodological limitations of the studies identified constrain the significance of this analysis.Despite the limited number of studies evaluating the benefits of patch pumps on PROs, there is increasing evidence that people with diabetes prefer patch pumps. Although there are numerous PROs for patch pumps, it is surprising that this aspect has been relatively understudied. More systematic evaluation studies of the benefits of patch pumps on PROs are needed.

OBJECTIVE To investigate the occupational and financial consequences for parents following the onset of type 1 diabetes in their child. RESEARCH DESIGN AND METHODS A questionnaire assessing occupational and financial situations before and in the first year after the onset of diabetes was distributed to all families with a child ≤14 years of age at diagnosis with a diabetes duration of at least 12 months in nine German pediatric diabetes centers. RESULTS Data of 1,144 children (mean age at diagnosis 6.7 [3.6] years; 46.5% female) and their families were obtained. Mothers’ occupational status reflected in paid working hours was significantly reduced in the first year after their child's diabetes diagnosis (P < 0.001). Overall, 15.1% of mothers stopped working, and 11.5% reduced working hours. Mothers of preschool children were particularly affected. Fathers’ working status hardly changed (P = 0.75). Nearly half of the families (46.4%) reported moderate to severe financial losses. Compared with an earlier similar study in 2003, significant negative occupational consequences for mothers and financial burden on families remained unchanged in 2018 (P = 0.59 and 0.31, respectively). CONCLUSIONS Mothers of young children with newly diagnosed diabetes experienced negative consequences in their occupational situation. This inequality for mothers can have long-term negative consequences for their mental health and future economic situation. There is an urgent need for action to reduce the burden on families and to provide professional, social, and regulatory support, especially for mothers of young children with diabetes.

ZusammenfassungKontinuierliches Glukosemonitoring (Continuous Glucose Monitoring – CGM) ist heute fest in Konsensusempfehlungen und Leitlinien zur Verbesserung der glykämischen Kontrolle bei Menschen mit insulinpflichtigem Diabetes mellitus verankert. In der täglichen Praxis werden im Besonderen HbA1c, Glukosevariabilität und Hypoglykämien durch die Nutzung von CGM positiv beeinflusst. Der Stellenwert von CGM bei Therapieentscheidungen wächst und birgt weitere vielfältige Potenziale. Dieser Übersichtsartikel stellt dar, welche Therapieoptionen auf der Basis von CGM-Daten bestehen, wie das ambulante Glukoseprofil und Trendpfeile Therapieentscheidungen beeinflussen können und welche Schulungskonzepte für Patienten angeboten werden. Auch werden zukünftige Felder für die Anwendung von CGM erörtert und diskutiert.

Continuous glucose monitoring (CGM) systems use trend arrows to accurately display the anticipated glucose curve for the user. These are used for both “real-time” glucose monitoring and for intermittent scanning glucose monitoring. Trend arrow data are used by people with diabetes to make corrections to their glucose control. It is essential that they are correctly interpreted when adjusting insulin doses and to ensure that appropriate treatment decisions are made. The aim of this article is to provide general treatment guidance for diabetes teams and for people with diabetes using CGM in the context of trend arrows. This is based on previous recommendations for interpreting trend arrows without losing sight of the need for individual therapy adjustment.

ZusammenfassungDie unterschiedlichen Systeme zum kontinuierlichen interstitiellen Glukosemonitoring nutzen Trendpfeile, mit denen dem Anwender in grafischer Form eine Prognose zum künftigen Glukoseverlauf angezeigt wird. Sie werden sowohl beim Glukosemonitoring mit „Real-Time“-Alarmen als auch beim Glukosemonitoring mit intermittierendem Scannen genutzt. Die Trendpfeile sind für viele Menschen mit Diabetes eine wichtige Grundlage für Stoffwechselkorrekturen, weshalb ihre Interpretation zur Voraussetzung für adäquate Therapieentscheidungen wird. Ziel dieser Publikation ist es, auf der Grundlage verfügbarer Vorschläge zur Trendpfeilinterpretation eine allgemein gültige Handlungsanweisung für Diabetesteams und Nutzer von kontinuierlichem Glukosemonitoring mit der Möglichkeit der notwendigen individuellen Anpassung zu geben.

Background and Methods: Randomized trials have shown that faster aspart (FA) improves glycemic control in patients with T1D. The German observational study GoBolus (NCT03450863) collected real-world clinical and patient-reported data of patients with T1D treated with basal/bolus therapy as multiple daily injections (MDIs), who were switched from other bolus insulins to FA by their physician. Results: Overall, 243 patients were enrolled, with a mean age of 49.9 years, mean baseline A1C of 8.1%, mean BMI of 28.1 kg/m2 and mean diabetes duration of 18.8 years: 55.6% were male. Over 24 weeks’ FA treatment, primary endpoint (A1C) decreased by 0.19% (p10 and >13.9 mmol/L) from 49.1% to 46.1% (p=0.03) and 20.4% to 17.9% (p=0.01), respectively, without change for time in hypoglycemia ( Conclusions: Switching bolus insulin to FA in patients with T1D on MDIs improved glycemic control, increased TIR and decreased time in hyperglycemia. Disclosure T. Danne: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Novo Nordisk A/S, Sanofi. M. Schweitzer: Employee; Self; Novo Nordisk A/S. W. Keuthage: Advisory Panel; Self; Deutschland GmbH, Novo Nordisk A/S, Roche Diabetes Care. Board Member; Self; Abbott, Berlin-Chemie AG. S. Kipper: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. Y. Kretzschmar: Employee; Self; Novo Nordisk A/S. J. Simon: None. R. Ziegler: Advisory Panel; Self; Abbott, Lilly Diabetes, Novo Nordisk A/S, Roche Diabetes Care. Consultant; Self; Novo Nordisk A/S, Roche Diabetes Care. Speaker’s Bureau; Self; Abbott, Dexcom, Inc., Novo Nordisk A/S, Roche Diabetes Care. Funding Novo Nordisk

Comprehensive knowledge, specific skills, and data-analysis competences are prerequisites of successful use of continuous glucose monitoring systems (CGM). SPECTRUM is a structured and manufacturer-independent training-program for real time CGM (rtCGM) comprising one web-based introduction and six modules (each 90 minutes) of face-to-face group sessions. SPECTRUM was evaluated longitudinally among adults with type 1 diabetes from 10 diabetes centers. Outcome parameters were rtCGM-knowledge and -skills (rtCGM-Profi-Check), satisfaction with the course, technology acceptance and metabolic control. Initially 120 participants with type 1 diabetes were included (mean age 42.4±13.4 years, diabetes duration 21.6±11.6 years, 56% female, mean HbA1c 7.70±1.34%). Data were collected at study entry, after the final group session, and at 6 months follow-up. The study was completed by 108 patients (10% dropped out, mainly due to scheduling problems). After training rtCGM knowledge (scale 0-40) improved by 43% (from 21.2±7.6 to 30.4±4.5; p SPECTRUM was shown to be effective in increasing the knowledge and skills about rtCGM in adults with type 1 diabetes. The effect was sustainable and independent from diabetes center and rtCGM-system used. Training participants showed an improvement in glycemic control and improved satisfaction and acceptance of rtCGM. Disclosure G. Freckmann: Advisory Panel; Self; Abbott, Sensile Medical AG. Consultant; Self; Beurer, iSens, Metronom Health, Pharmasens, Profusa, Inc., Roche Diabetes Care. Speaker’s Bureau; Self; Novo Nordisk A/S. S. Schlueter: Advisory Panel; Self; A. Menarini Diagnostics, Abbott. Consultant; Self; Roche Diabetes Care. Speaker’s Bureau; Self; Ascensia Diabetes Care, AstraZeneca, Berlin-Chemie AG, Dexcom, Inc., Medtronic, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Roche Diabetes Care, Sanofi-Aventis Deutschland GmbH, Ypsomed AG. Other Relationship; Self; Springer Publishing Company, Verlag Kirchheim & Co. GmbH. P. Wintergerst: None. L. Heinemann: Consultant; Self; Becton, Dickinson and Company, LifeCare, Inc., Roche Diabetes Care. Stock/Shareholder; Self; Profil Institute for Clinical Research. T. Rückert: None. A. Hinz: Research Support; Self; Institut for Diabetestechnologie Ulm, Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Berlin-Chemie AG, Eli Lilly and Company. M. Wernsing: Advisory Panel; Self; Abbott. Research Support; Self; Roche Diabetes Care. F. Thienel: Research Support; Self; Roche Diabetes Care. Speaker’s Bureau; Self; Abbott. T. Biester: Advisory Panel; Self; AstraZeneca. Speaker’s Bureau; Self; Dexcom, Inc., Medtronic, Roche Diabetes Care, Sanofi, Ypsomed AG. P. von Blanckenburg: None. W. Keuthage: Advisory Panel; Self; Deutschland GmbH, Novo Nordisk A/S, Roche Diabetes Care. Board Member; Self; Abbott, Berlin-Chemie AG. R. Ziegler: Advisory Panel; Self; Abbott, Lilly Diabetes, Novo Nordisk A/S, Roche Diabetes Care. Consultant; Self; Novo Nordisk A/S, Roche Diabetes Care. Speaker’s Bureau; Self; Abbott, Dexcom, Inc., Novo Nordisk A/S, Roche Diabetes Care. E. Martin: None. M. Holder: None. D. Deiss: Advisory Panel; Self; Abbott, Roche Diabetes Care. Consultant; Self; Senseonics. G. Buchal: None. L. van den Boom: Advisory Panel; Self; Medtronic. K. Lange: Consultant; Self; Abbott, Dexcom, Inc., Medtronic. Funding Dexcom, Inc.; Roche Diabetes Care; Sanofi; Menarini Group; Kirchheim Verlag; Medtronic

BACKGROUND Continuous subcutaneous insulin infusion (CSII) is commonly used in patients with diabetes. Accurate and reliable delivery by insulin pumps is essential for a safe and effective therapy, particularly when using small doses. In this study, accuracy of bolus and basal rate delivery of various available insulin pumps was evaluated. METHODS In total, 13 insulin pump systems were tested: eight durable pumps with different infusion sets and one patch pump. Based on IEC 60601-2-24, insulin delivery was measured by recording weight gain of a beaker into which insulin was infused by the pumps. Bolus accuracy was determined by individually weighing 25 consecutive 0.1 or 1.0 U boluses and basal rate accuracy was determined during basal rate delivery of 0.1 or 1.0 U/h for 72 hours. For analyses, basal rate delivery was divided into 1-hour windows and deviation from target was calculated. RESULTS Regarding different systems, average 0.1 U bolus delivery was -2% to +9% of the intended volume with 53% to 96% of boluses within ±15% of target. During 0.1 U/h basal rate delivery, most pumps showed an initial over-delivery for the first few hours. Three systems reached a total basal rate error

Biomedical outcomes for people with diabetes remain suboptimal for many. Psychosocial care in diabetes does not fare any better. “Artificial pancreas” (also known as “closed-loop” and “automated insulin delivery”) systems present a promising therapeutic option for people with diabetes (PWD)—simultaneously improving glycemic outcomes, reducing the burden of self-management, and improving health-related quality of life. In recent years there has emerged a growing movement of PWD innovators rallying behind the mantra #WeAreNotWaiting, developing “do-it-yourself artificial pancreas systems (DIY APS).” Self-reported results by DIY APS users show improved metabolic outcomes such as impressive stability of glucose profiles, significant reduction of A1c, and more time within their glycemic target range. However, the benefits remain unclear for the broader population of PWD beyond these highly engaged, highly tech-savvy users willing and able to engage in the demands of building and maintaining their DIY APS. We discuss the challenges faced by key stakeholder groups in terms of potential collaboration and open debate of these challenges.

Die grundlegenden Prinzipien der intensivierten Insulintherapie nach dem Basis-Bolus-Prinzip mit Injektions- oder Pumpentherapie haben sich in der Kinderdiabetologie durchgesetzt. Wahrend Vorschulkinder ab Manifestation mit (gegebenenfalls sensorunterstutzer) Pumpentherapie behandelt werden, ist die intensivierte Insulintherapie (ICT) mit mehrfachen taglichen Injektionen zunachst die erste Wahl der Therapie ab dem Schulalter. Fur die Insulintherapie im padiatrischen Alter werden wegen der notwendigen Flexibilitat der Therapieanpassung keine Misch- oder Kombinationsnsuline verwendet. Technologische Neuentwicklungen wie die kontinuierliche Glukosemessung (CGM) und sensorunterstutzte Pumpentherapie (SuP) haben bei Kindern und Jugendlichen mit Typ-1 Diabetes wegen der alterstypischen Stoffwechselschwankungen eine besondere Bedeutung.

Background: The ambulatory glucose profile (AGP) uses the wealth of data that are generated by continuous glucose monitoring, including flash glucose monitoring technologies, to provide a visual representation of glucose levels over a typical standard day of usually the most recent two weeks for a person with diabetes and helps to identify patterns and trends in glucose control. The AGP allows certain patterns of glucose levels to be identified and analyzed, such that treatment adjustments can be made, and new individual treatment goals can be defined. This helps to ensure increased treatment satisfaction and adherence, quality of life, and an improvement in metabolic management for people with diabetes. Objective: To date, a range of approaches exists for interpreting the information contained in an AGP, with different priorities given to identifying and targeting patterns of hypoglycemia and the degree of variability and stability underlying the glucose levels. The objective of the present recommendation is to describe the steps for assessing an AGP in detail and to illustrate these steps using visual examples. Conclusion: This paper describes the consensus recommendations from a group of German expert diabetologists on the necessary steps for assessing an AGP in a structured and detailed way and to explain these steps using practical clinical examples.

ZusammenfassungKontinuierliches Glukosemonitoring resultiert in großen Datenmengen, die mithilfe des Ambulanten Glukoseprofils (AGP) standardisiert zusammengefasst und grafisch dargestellt werden können. Das AGP ermöglicht die Auswertung der Glukosewerte hinsichtlich verschiedener Parameter wie Hypo- und Hyperglykämien, Zeit im Zielbereich (Time in Range – TIR), Glukosevariabilität, Glukosestabilität und Glucose Exposure. Des Weiteren ermöglicht es eine einfache und verständliche Interpretation des glykämischen Profils. Sich daraus ergebende Therapie- und Verhaltensanpassungen können die glykämische Kontrolle von Menschen mit Diabetes verbessern. Die vorliegenden praxisnahen Empfehlungen zur Auswertung des AGP stellen eine Expertenmeinung dar, die von praxisnahen Diabetologen erstellt wurde. Anhand von Beispielen und Empfehlungen wird das Vorgehen schrittweise erläutert und zusammengefasst.

ZusammenfassungDer Typ-1-Diabetes ist die häufigste Stoffwechselerkrankung im Kindes- und Jugendalter – die Zahl an Betroffenen steigt stetig an. Dabei sind die Belastungen der täglichen, ja sogar stündlichen Behandlung ohne Pause und ohne Ferien real und nicht zu unterschätzen. Moderne Technologien können helfen, diese Belastungen zu reduzieren. Sie umfassen schnelle Insuline zur besseren Abdeckung von Kohlenhydraten, Verzögerungsinsuline, deren Wirkprofil eine Variation des Injektionszeitpunkts bei wechselnden Tagesabläufen erlaubt, Insulinpumpen, verschiedene Methoden der kontinuierlichen Glukosemessung und schließlich die Möglichkeiten der systematischen digitalen Datenauswertung. All diese Technologien können jedoch nur dazu beitragen, die immer noch notwendige Therapie konsequent umzusetzen. Der Patient selbst bleibt immer gefordert, täglich mehrfach die richtige Menge Insulin zum richtigen Zeitpunkt unter die Haut zu injizieren.

Continuous subcutaneous insulin infusion (CSII) is a very common therapy for children with type 1 diabetes. Due to physiological differences they have other requirements for their insulin pump than adults. The main difference is the need for very low basal rates. Even though most available insulin pumps reach a high accuracy at usual basal rates, accuracy decreases for lower rates. In addition, the lowest delivered amount at 1 time is limiting the fine tuning of the basal rate as well as the option for temporary basal rates. Alarms in case of occlusions depend on accumulation of a certain amount of insulin in the catheter, and therefore the time until such an alarm is triggered is much longer with lower basal rates. Accordingly, the risk for hyperglycemia developing into diabetic ketoacidosis increases. The availability of bolus advisors facilitates the calculation of meal and correction boluses for children and their parents. However, there are some differences between the calculators, and the settings that the calculation is based on are very important. Better connectivity, for example with a system for continuous glucose monitoring, might help to further increase safety in the use of CSII in children. When selecting an insulin pump for a child, the features and characteristics of available pumps should be properly compared to ensure an effective and safe therapy.

Optimal usage of continuous glucose monitoring (CGM) requires adequate preparation and training. Patients using a CGM system without special training often do not achieve their intended improvement of metabolic control. Some stop using the system due to disappointing results. For this reason a structured training programme called ‘SPECTRUM’ was developed in Germany to ensure a high-quality standard for the initiation of CGM systems. This programme is suitable for patients of all age groups and is applicable to all CGM systems and all forms of insulin therapy. Structured curricula (adults, parents of young children, adolescents) were developed enabling diabetes centres with less experience to offer comprehensive CGM training. Key requirements of SPECTRUM were (1) independent from manufactures and (2) product-neutrality enabling certification for reimbursement after formal evaluation within the framework of a large clinical trial. SPECTRUM was published in January 2016 in German and translations into other ...

Die kontinuierliche Glukosemessung (CGM) wird auch im Kindes-und Jugendalter immer haufiger eingesetzt. Der vor Kurzem veroffentlichte Beschluss des G‑BA wird den Zugang zu dieser Technologie als Kassenleistung weiter offnen. Voraussetzungen fur die erfolgreiche Langzeitnutzung von CGM sind realistische Erwartungen der Kinder und Jugendlichen mit Typ-1-Diabetes sowie ihrer Eltern, alltagsorientierte Schulung und die strukturierte Reflexion der taglichen Erfahrungen mit dem System. Mit SPECTRUM steht das erste herstellerunabhangige und produktneutrale CGM-Schulungs- und Behandlungsprogramm fur Eltern mit jungen Kindern, fur Jugendliche und fur Erwachsene mit Diabetes zur Verfugung. Seine Implementierung in der padiatrischen Diabetologie wird bundesweit durch Train-the-Trainer-Seminare fur interessierte Teammitglieder durch die Arbeitsgemeinschaft fur Padiatrische Diabetologie (AGPD e. V.) unterstutzt. In Planung sind die Evaluierung und Zertifizierung des Schulungsprogramms.

Introduction Regarding pediatric diabetes, hospital admission for acute complications of type 1 diabetes (T1D) has often been investigated, but little is known about other causes of hospitalization. This study aimed to explore the total burden of hospitalization in individuals with diabetes Methods Using the German Diagnosis-Related Groups data for 2015, we examined the frequencies of hospitalization with diabetes (20 251 inpatient cases), stratified by diabetes type [T1D, type 2 diabetes (T2D), other specified diabetes types (T3D), and unclear diabetes], and without diabetes (1 269 631 inpatient cases). Using estimates of the population at risk with T1D, T2D, and without diabetes, we evaluated hospitalization rates (per patient-year) by Poisson regression. For T1D, T2D, and T3D, we investigated the most frequent diagnoses and the median length of stay. Most analyses were stratified by sex, age-group and east/west residence. Results Children and adolescents with diabetes had a 6 to 9 times higher hospitalization risk than peers without diabetes (hospitalization rate 0.09). The hospitalization rate was higher for T2D compared with T1D (0.84 vs. 0.53, P Conclusion Hospitalization rate in pediatric diabetes in Germany remained high, especially for T2D patients, girls with T1D, and young children.

In continuous subcutaneous insulin infusion (CSII) therapy, bolus doses are delivered to cover meals and to correct high blood glucose values. Data for bolus dosing accuracy were already presented for different insulin pump systems. In this study, two lately released insulin pumps were tested accordingly. Two new insulin pumps (MiniMed® 670G and mylife™ YpsoPump®) with soft cannula were tested. In an experimental setting following EN 60601-2-24, both pumps were installed with the tip of the cannula in a water-filled beaker placed on an electronic balance. To avoid evaporation an oil film was applied. After a run-in period, 25 successive 1.0 U and 0.1 U boluses and 12 successive 10 U boluses were delivered and weighed individually. In addition, time for a bolus delivery of 10 U was recorded. Each insulin pump was tested 9 times. While for 10 U and 1 U boluses 100% of deliveries of both pumps were within ±15% of target, only 85% (670G) and 88% (YpsoPump), respectively, of 0.1 U boluses were within these limits. Delivery time of a 10 U bolus was different between the two pumps, 6.7 min (standard speed) and 43 sec (quick) for 670G vs. 19 sec for YpsoPump, but complied with the respective manufacturer’s labeling. These results fit to the previously tested durable insulin pumps for which similar percentages of deliveries within ±15% of target (100% for 10 and 1 U and 71% to 96% for 0.1 U) were observed. As delivery accuracy decreases with smaller bolus doses, care should be given especially when treating small children with CSII. Disclosure R. Ziegler: Advisory Panel; Self; Abbott, Lilly Diabetes, Novo Nordisk A/S, Roche Diabetes Care. D. Waldenmaier: None. J. Mende: None. C. Haug: None. G. Freckmann: Advisory Panel; Self; Abbott, Novo Nordisk Pharma GmbH, Sensile Medical AG. Consultant; Self; Metronom Health Europe, Roche Diabetes Care, Sanofi. Speaker’s Bureau; Self; Ascensia Diabetes Care, Dexcom, Inc., Ypsomed AG. Funding Roche Diabetes Care GmbH

Background: Insulin pumps are used for basal rate and bolus insulin delivery in patients with diabetes. In this in vitro study, accuracy of delivery of different commercial insulin pumps was evaluated. Materials and Methods: Accuracy of 10 different insulin pump systems (5 durable pumps with different insulin infusion sets and 1 patch pump) was tested with a microgravimetric method. Mean bolus accuracy of 25 successive 1 U boluses and of 12 successive 10 U boluses was assessed, and delivery time for 10 U boluses was measured. Basal rate accuracy at 1.0 U/h was evaluated for 72 h and for individual 1-h windows. Results: Mean bolus delivery was within ±5% of target for both tested bolus sizes, but precision of individual boluses was higher with the larger boluses. Delivery times varied between the different pump models but agreed with the specifications of the respective manufacturers. Regarding basal rate accuracy, the total deviation for 72 h was very small in all pumps; however, larger deviations were observed during the first 12 h. For the patch pump, large variations between individual 1-h windows were observed. Conclusions: In general, all compared insulin pump systems showed a similar level of accuracy. Differences, especially between durable pumps and the patch pump, were observed when considering each hour of basal rate delivery separately.

The perceived value and consistent use of continuous glucose monitoring (CGM) systems depends in part on their accuracy. We assessed the performance of a sixth-generation CGM system (Dexcom G6) in children and adolescents.Forty-nine participants (6-17 years of age, mean ± SD of 13.5 ± 3.3 years), all with type 1 diabetes, enrolled and data were available from 37. Each participant wore 1 sensor for up to 10 days and was asked to undergo an in-clinic visit lasting 6-12 hours for frequent blood glucose (BG) sample testing on one of the sensor wear days. Estimated glucose values (EGVs) from the G6 system were compared with venous BG values measured with a laboratory reference instrument (YSI).The overall mean absolute relative difference (MARD) for 1387 EGV-YSI pairs was 7.7%, and the overall percentage of EGVs within 20% or 20 mg/dL of the YSI reference value (for YSIor ⩽100 mg/dL, respectively, the "%20/20") was 96.2%. The %20/20 was 92.1% on Day 1 and 91.0% on Day 10 of sensor wear. For EGVs70 mg/dL, 92.6% of the YSI values were within 20 mg/dL and for EGVs250 mg/dL, 100% of the YSI values were within 20%. Differences between EGVs and YSI values in over 99.9% of the pairs posed no or only slight clinical risk as evaluated by surveillance error grid analysis.The accuracy of the G6 CGM system in pediatrics may encourage consistent use of the system and contribute to improved glycemic outcomes in this population.

Background: Optimal usage of continuous glucose monitoring (CGM) requires adequate training of the users. Providing patients with a CGM system without such a training usually doesn’t lead to the intended improvement in metabolic control. Methods: In Germany we developed a structured training program (“SPECTRUM”) to ensure a high quality standard for the use of CGM systems. Results: This program is suitably for patients of all age groups and is applicable to all CGM systems and all forms of insulin therapy. A curriculum was also developed so that training centers with less experience with CGM could become capable of offering comprehensive CGM training. Conclusions: We believe that usage of such a program can be an important step forward in achieving more widespread acceptance and use of CGM systems. Translations in other languages and evaluation with a controlled clinical trial are planned.

Giving a bolus is one major part in multiple dose insulin therapy (MDI) along with basal insulin substitution. To adjust the bolus optimally, different factors like carbohydrate content and composition of the meal, correction factors, and timing have to be considered. Advances in technologies like bolus advisors can assist the patients but still there a several open questions and technical challenges regarding boluses. This commentary provides an opportunity to address several of the above-mentioned factors influencing the result of bolusing. It shall draw attention to those factors and address the current opportunities, for example, continuous subcutaneous insulin infusion (CSII), as well as the need for further studies which can help to improve diabetes insulin therapy by means of the correct use of boluses.

In general, patients with diabetes performing self-monitoring of blood glucose (SMBG) can strongly rely on the accuracy of measurement results. However, various factors such as application errors, extreme environmental conditions, extreme hematocrit values, or medication interferences may potentially falsify blood glucose readings. Incorrect blood glucose readings may lead to treatment errors, for example, incorrect insulin dosing. Therefore, the diabetes team as well as the patients should be well informed about limitations in blood glucose testing. The aim of this publication is to review the current knowledge on limitations and interferences in blood glucose testing with the perspective of their clinical relevance.

An increasing number of patients with type 2 diabetes mellitus (T2DM) use insulin pumps. The first insulin pumps especially designed for patients with T2DM have recently become available. However, national guidelines do not primarily recommend the use of continuous subcutaneous insulin infusion (CSII) for this patient group. The effectiveness of CSII in T2DM has not yet been convincingly demonstrated, despite some positive evidence. An overview and an assessment of various studies to date will be given. T2DM is a heterogeneous disease with a substantial phenotypic variability; therefore, it is difficult to provide general conclusions about the effectiveness of CSII in T2DM therapy. The pump types, characteristics, and associated barriers may play a relevant role for therapy outcome. Most advanced functions like various bolus dosages offered by conventional insulin pumps are not needed for T2DM treatment and complicate the device handling for this subject group. Additionally, new technologies like increased connectivity, advanced software features, and interoperability are currently becoming available representing further barriers. The implementation of this technological progress might be a benefit for pumps for T2DM as well. However, these have not been sufficiently examined either and increased security challenges due to integrated peripheral components should not be neglected in terms of a sound cybersecurity. Pump features and handling for patients with T2DM should be as easy as possible, indicating a need for insulin pumps specially designed for patients with T2DM. However, it has to be investigated if pumps designed for T2DM are more effective than other intensified insulin regimens.