Prise en charge du diabète instable : approche humaine ou technologique ?

The main feature of unstable diabetes is extreme glucose variability, responsible for clinical events, mostly recurrent and/or severe hypoglycemia, impairing quality of life. Technology will allow to standardize the definition of unstable diabetes and to provide a better patient phenotyping. Technology offers several therapeutic options: insulin pumps coupled with glucose sensors, with threshold or predictive low glucose suspend feature, closed-loop insulin delivery devices, cell therapy. Metabolic improvement provided by these treatments must be balanced with their acceptability and own side effects. The role of the diabetologist is to help identifying some underlying causes for glucose instability, and to enlighten the therapeutic decision. Overall, unstable diabetes is a typical situation where shared medical decision is recommended, illustrating that technology and human support are both required for appropriate diabetes care.