Mein Freund, das AID-System
摘要
A 40-year-old man with type 1 diabetes and cognitive impairment, in particular pronounced dyscalculia, has been cared for in our practice for many years. Despite a high level of commitment and support from his sister, who is also his legal caregiver, he was unable to achieve adequate metabolic control (HbA1c was permanently > 10%). As flexible insulin dosing was not possible due to the cognitive deficits, fixed doses were administered. An automated insulin delivery (AID) system was introduced in January 2024 to improve diabetes control and reduce barriers to therapy. The preparation included individualized tables for carbohydrate estimation, intensive training, and close family support. Practical tasks such as changing catheters were initially carried out together with his sister. The introduction of the AID system led to a significant improvement in HbA1c values within one year (from 10.2% to 7.3–7.9%). The patient showed a high level of satisfaction and increasing independence. In a later phase, with reduced support from his sister, there was a slight increase in HbA1c to 8.0%. The evaluation of the device data showed increased bolus omissions and sensor failures, so that an adjustment of the AID settings and, if necessary, an intensification of care is planned. This case shows that people with cognitive impairments can also benefit considerably from AID systems—provided that they receive structured training and intensive support from the diabetes team and relatives.