Intensive ambulatory treatment of insulin-dependent diabetes.
The therapy for insulin-dependent diabetes has been changing in the last 3 years with the increasing application of intensive ambulatory treatment programs involving self-monitoring of blood glucose levels by the patient. Insulin is administered either as multiple manual daily injections or as a continuous subcutaneous infusion delivered by a portable pump. We discuss the implementation, efficacy, complications (including recent reports of deaths in pump-treated patients), and cost of such programs. The potential effectiveness in preventing the long-term complications of diabetes warrants offering a program of self-monitoring of blood glucose levels combined with multiple manual daily insulin injections as a routine treatment option to virtually all patients with insulin-dependent diabetes. Additional observations on safety and efficacy are needed before insulin pump treatment can be considered a routine option. Furthermore, whether intensive treatment involving either manual or pump administration of insulin alters the risk of hypoglycemia as compared with conventional management remains to be established.
D000553:Ambulatory Care / Q000379:methods*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage; D007332:Insulin Infusion Systems / Q000009:adverse effects / Q000191:economics; D011247:Pregnancy; D012646:Self Administration; D012648:Self Care
D007328:Insulin