Expertenaustausch zum Einsatz von kontinuierlichem Glukosemonitoring (CGM) im Diabetesmanagement: Eine aktuelle Bestandsaufnahme und Blick in die Zukunft

CGM mit Darstellung der aktuellen Glukosewerte (rtCGM) ist aktuell einer der wichtigsten diagnostischen Optionen in der Diabetologie. Es ermöglicht eine umfangreiche und unmittelbare Unterstützung und Erleichterung des Diabetesmanagements, besonders wenn eine Insulintherapie angewendet wird. Weiterhin stellt rtCGM den notwendigen Systempartner für die Steuerung der automatisierten Insulinabgabe in AID-Systemen dar. In Verbindung mit Smart-Pens unterstützt ein rtCGM die korrekte Durchführung des Insulinmanagements und erinnert an Bolusinjektionen.

RtCGM-Daten sind heute das Fundament des personalisierten Datenmanagements und Alltagscoachings und stellen die Basis der Digitalisierung und telemedizinischen Intervention dar. Die Möglichkeit der interoperablen Nutzung ist aus therapeutischer Sicht eine zentrale Eigenschaft eines rtCGMs und kann zur Erweiterung der Indikationen, unabhängig von Diabetestyp oder Therapieform führen. Dies könnte auch den vorübergehenden oder intermittierenden Einsatz bei Menschen mit Typ-2-Diabetes ohne Insulinbehandlung betreffen. Kürzlich veröffentlichte internationale Leitlinien, z.B. der Amerikanischen Gesellschaft für klinische Endokrinologie (AACE) fordern auf der Basis umfangreicher Evidenz, dass die Glukosemessung mit einem rtCGM für alle Menschen mit Diabetes nutzbar und verfügbar sein sollte. Bereits in der Phase gestörter Glukosetoleranz kann ein rtCGM-System als Alltagscoaching oder Biofeedback bei Einbettung in ein Gesamtbehandlungskonzept unterstützen, mit dem Ziel aktiver und fundierter Handlungen des Anwenders im Diabetesalltag.

Die Vielfalt der Nutzungsoptionen und die immer schnelleren technischen Innovationszyklen von rtCGM-Systemen wurden mit Blick auf aktuelle Anforderungen und die notwendigen Strukturanpassungen des Gesundheitssystems von einer rtCGM-erfahrenen Expertengruppe diskutiert. Ziel war es, konkrete Lücken in der Versorgungsstruktur sowie potenzielle Handlungsfelder in der Diabetologie zu identifizierten und mögliche Indikationserweiterungen für den Einsatz von rtCGM darzustellen. Dieses, sowie die Erkenntnisse und Schlussfolgerungen der Diskussionen werden in diesem Artikel dargestellt.

Increased transperitoneal bacterial translocation in laparoscopic surgery

BACKGROUND

The indications for laparoscopic surgery have expanded to include diseases possibly associated with peritonitis such as appendicitis, perforated peptic ulcers, and diverticulitis. The safety of carbon dioxide (CO2) pneumoperitoneum in the presence of peritonitis has not been proved. Our previous investigations demonstrated increased bacteremia associated with CO2 insufflation. In effort to clarify the relative effects of intraabdominal pressure and type of gas, this study was designed to measure bacterial translocation with different gases at different pressures of pneumoperitoneum.

METHODS

For this study, 110 rats were given intraperitoneal bacterial innoculations with Escherichia coli and equally divided into five groups of 20 animals each. The study groups included a control group with no pneumoperitoneum administered (n = 30), insufflation at a commonly used pressure of 14 mmHg with helium (n = 20) and CO2 (n = 20), and low insufflation at 3 mmHg with helium (n = 20) and CO2 (n = 20) in an effort to minimize influences related to pressure. Blood cultures were checked at 15-min intervals for the first 45 min, then hourly thereafter for a total of 165 min after peritoneal inoculation with 2 x 10(7) E. coli.

RESULTS

There is increased risk of bacterial translocation in comparing groups that underwent pneumoperitoneum with those that did not in the rat peritonitis model. Furthermore, these findings are dependent on the presence or absence of gas, but not necessarily on the type of gas used for insufflation. In the low-pressure groups of both gases (helium and CO2), bacterial translocation was significantly increased, as compared with the control group. Low pressure also was associated with increased bacterial translocation, as compared with high pressure, but beyond 30 min of insufflation, no significant differences were apparent.

CONCLUSIONS

The risk of bacterial translocation in the E. coli rat peritonitis model is increased with insufflation using CO2 or helium, and this effect is more significant at lower pressures (3 mmHg) than at higher pressures (14 mmHg). However, no clinically applicable conclusions regarding the relative effects from type of gas or insufflation pressures could be confirmed.

Psychoanalytic interpretation of the Rorschach: do we have better hieroglyphics?

Schafer (1954) advanced the "Psychoanalytic Interpretation in Rorschach Testing" and asserted that thoughtful interpretation involved more than translating hieroglyphics or scores. In this book, he presented his thesis by describing four defensive styles (repression, denial, projective, and obsessive-compulsive) at various levels of severity of psychopathology. To investigate whether the Structural Summary data from Exner's (1986) Comprehensive System, with its improved reliability and validity and additional scores, allow one to make similar distinctions among the types of defense and severity of disturbance, we rescored the Schafer records. The results of this conservative test of Exner's system suggest that (a) the Comprehensive System reliably distinguishes the repressive style from the other styles, and (b) scores alone may provide adequate measures of severity of disturbance even with form quality excluded. We concluded that Rorschach scores must be understood as complex products of multiple psychological operations and may correspond to different subjective experiences in various contexts.

Usefulness of structural Rorschach data in identifying inpatients with depressive symptoms: a preliminary study

To explore the usefulness of various structural Rorschach data in identifying psychiatric inpatients with symptoms of depression, 54 adult inpatients were administered a Rorschach. Results indicated that the Comprehensive System, Rorschach Depression Index did not identify many of these individuals as depressed, but did identify most of the extratensive depressed individuals. Each variable included in the Depression Index and other potential, Rorschach correlations of depression were also investigated. Most of them were found to occur more often among these depressed patients than among nonpatients. Furthermore, adding other variables and using more liberal cutoffs may result in more accurate identification of patients with depressive symptoms.

The reliability of Rorschach variables for inpatients presenting symptoms of depression and/or helplessness

Fifty newly admitted patients presenting symptoms of depression and/or helplessness were recruited to participate in a study concerning depression and randomized into two groups. Rorschachs were administered shortly after admission and then three or four days later. The subjects in the experimental group were instructed to give responses different than they had in the first test. Approximately two-thirds of the responses given by the experimental group in test 2 were different from those in test 1, whereas the control subjects repeated 66% of their test 1 answers in test 2. Retest correlations for 28 variables critical to interpretation show that the two groups differed significantly for four. The retest correlations for four of five variables often used as indices of depressive features were significantly high for both groups. Unusual findings are noted in the retest correlations for FM and m for the Control group and questions are raised concerning the modest retest correlations for CF and C + Cn versus the more commonplace summation of CF + C.