[Prevention of late complications of insulin dependent diabetes. How far and at what price?].
The essential role of chronic hyperglycaemia in the development of complications was suspected and accepted in Europe more than 20 years ago. A large number of epidemiological, clinical biochemical and experimental arguments together with certain clinical trials have demonstrated the importance of the best possible glycaemic control in patients with diabetes mellitus. Changing ideas, the development of new equipment (pumps, pens, single-use seringues) and the widespread use of self-measurement techniques has confirmed the validity of this attitude. Recent results of the American study (DCCT Diabetes Control and Complications Trial) has recently clearly confirmed this position which is now firmly established and no longer a subject of debate. There are nevertheless, certain limitations: the aim of glucose normalization should not be limited to patients with a risk of late microvascular complications, i.e. in patients with a sufficiently long life-expectancy, or those whose short-term survival is not threatened and who do not have a life-threatening intercurrent disease. An increased risk for hypoglycaemia, including the most severe episodes, is the price to pay for intensifying treatment. This risk cannot be totally eliminated, but can be minimized by intensifying patient training and, perhaps, by using new tools such as external pumps or implantable pumps. In any case, no matter how much time and effort are spent, the fact that the basic tool is imperfect (peripherally administered insulin without feedback control) means that further research is required to find other ways administering insulin.(ABSTRACT TRUNCATED AT 250 WORDS)
Slama
G
G
Hôtel-Dieu de Paris.
Selam
J L
JL
D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000191:economics / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D017048:Health Care Costs; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008297:Male
D007328:Insulin
Prévention des complications tardives du diabète insulinodépendant. Jusqu'à quel point et à quel prix?