Autosurveillance glycémique et insulinothérapie intensifiée dans le diabète de type 1

Self monitoring of blood glucose (SMBG) is mandatory to adjust intensified insulin regimens such as basal-bolus regimens with insulin analogs or continuous subcutaneous insulin therapy with pumps. Patient education allows the efficacy of these tools, and there is an inverse relationship between the frequency of SMBG and HbA1c levels in type 1 diabetic patients on intensified insulin therapy. American and French diabetes associations recommend at least three or four glucose determinations per day in type 1 diabetic patients, however, four to six determinations per day would probably be more efficient to reach glycemic goals. Technical and psychological limits to frequent blood glucose monitoring can lessen the efficacy of the treatment. Continuing education is necessary to encourage the patients to progress from passive glucose monitoring to active treatment adjustment. Continuous glucose monitoring will be a major step to help type 1 diabetic patients obtaining and maintaining tight glucose control.