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.