Janez Andrej, Battelino Tadej, Klupa Tomasz, Kocsis Győző, Kuricová Miriam, Lalić Nebojša, Stoian Anca Pantea, Prázný Martin, Rahelić Dario, Šoupal Jan, Tankova Tsvetalina, Zelinska Nataliya
Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia.
University Medical Center Ljubljana, Ljubljana, Slovenia.
Diabetes Ther. 2021 Dec;12(12):3107-3135. doi: 10.1007/s13300-021-01160-5. Epub 2021 Oct 25.
In both pediatric and adult populations with type 1 diabetes (T1D), technologies such as continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), or sensor-augmented pumps (SAP) can consistently improve glycemic control [measured as glycated hemoglobin (HbA1c) and time in range (TIR)] while reducing the risk of hypoglycemia. Use of technologies can thereby improve quality of life and reduce the burden of diabetes management compared with self-injection of multiple daily insulin doses (MDI). Novel hybrid closed-loop (HCL) systems represent the latest treatment modality for T1D, combining modern glucose sensors and insulin pumps with a linked control algorithm to offer automated insulin delivery in response to blood glucose levels and trends. HCL systems have been associated with increased TIR, improved HbA1c, and fewer hypoglycemic events compared with CSII, SAP, and MDI, thereby potentially improving quality of life for people with diabetes (PwD) while reducing the costs of treating short- and long-term diabetes-related complications. However, many barriers to their use and regional inequalities remain in Central and Eastern Europe (CEE). Published data suggest that access to diabetes technologies is hindered by lack of funding, underdeveloped health technology assessment (HTA) bodies and guidelines, unfamiliarity with novel therapies, and inadequacies in healthcare system capacities. To optimize the use of diabetes technologies in CEE, an international meeting comprising experts in the field of diabetes was held to map the current regional access, to present the current national reimbursement guidelines, and to recommend solutions to overcome uptake barriers. Recommendations included regional and national development of HTA bodies, efficient allocation of resources, and structured education programs for healthcare professionals and PwD. The responsibility of the healthcare community to ensure that all individuals with T1D gain access to modern technologies in a timely and economically responsible manner, thereby improving health outcomes, was emphasized, particularly for interventions that are cost-effective.
在患有1型糖尿病（T1D）的儿童和成人中，持续皮下胰岛素输注（CSII）、持续葡萄糖监测（CGM）或传感器增强泵（SAP）等技术可以持续改善血糖控制[以糖化血红蛋白（HbA1c）和血糖达标时间（TIR）衡量]，同时降低低血糖风险。与每日多次胰岛素注射（MDI）自我注射相比，使用这些技术可以提高生活质量并减轻糖尿病管理负担。新型混合闭环（HCL）系统代表了T1D的最新治疗方式，它将现代葡萄糖传感器和胰岛素泵与链接的控制算法相结合，以根据血糖水平和趋势提供自动胰岛素输注。与CSII、SAP和MDI相比，HCL系统与更高的TIR、改善的HbA1c以及更少的低血糖事件相关，从而有可能改善糖尿病患者（PwD）的生活质量，同时降低治疗短期和长期糖尿病相关并发症的成本。然而，在中东欧（CEE），其使用存在许多障碍以及地区不平等现象。已发表的数据表明，缺乏资金、卫生技术评估（HTA）机构和指南不完善、对新疗法不熟悉以及医疗系统能力不足阻碍了糖尿病技术的获取。为了优化中东欧地区糖尿病技术的使用，召开了一次由糖尿病领域专家组成的国际会议，以梳理当前区域获取情况、介绍当前国家报销指南，并推荐克服采用障碍的解决方案。建议包括区域和国家层面发展HTA机构、有效分配资源，以及为医疗专业人员和糖尿病患者制定结构化教育计划。强调了医疗界有责任确保所有T1D患者及时且经济合理地获得现代技术，从而改善健康结果，特别是对于具有成本效益的干预措施。
