L'éducation thérapeutique du patient diabétique, ou apprendre à gérer l'incertitude

Diabetes includes various pathologies with unknown mechanisms and variable evolution. Goal of diabetes treatment is to prevent complications. Prevention of complications needs correction of their known risk factors but their occurrence for each patient is largely uncertain. Long term efficacy, tolerance and safety of the antidiabetic drugs are far from being certain. It's obvious for the new drugs, but it's also true although to a less degree for the oldest ones. Moreover some patients are responders and others aren't. In spite of pharmacogenetic progress, today it's necessary to deal with testing. Finally there are many reasons to explain the variability of glycemic value. Except insufficient reliability of capillary glucose measurement, we should insist on poor reproducibility of day to day insulin resorption by subcutaneous route, and/or disparity of insulin sensitivity between patients. High insulin sensitivity provokes large glycemic variability. Glycemic instability is often wrongly interpreted as a psychic instability. These several uncertainties have major implications on therapeutic education and its technical pedagogical and psychological fields.