[What allows a type 1 diabetic to be well controlled]

Long-term studies carried out in type 1 insulin-dependent diabetic population have clearly demonstrated a tight glycaemic control to be a key factor in type 1 diabetes mellitus survival. A better HbA1c is associated with lesser retina and kidney complications. The DCCT study has clearly shown intensive insulin treatment (3 or more insulin injections per day) to be superior to conventional regimen (one or 2 insulin injections per day) to reduce the risk for development (primary prevention) of late diabetic complications. However, such intensive insulin regimen should be started early, maintained on the long-term, and should be based on a regular and adequate blood glucose self-monitoring. The beneficial effects of a tight glycaemic control to reduce the risk for progression (secondary prevention) of late diabetic complications has not been proved yet. Consequently, at this stage, non-glycaemic interventions (antihypertensive treatment with angiotensin-converting-enzyme inhibitors, laser photocoagulation surgery) are the most useful treatment modalities. The global prognosis of type 1 insulin-dependent diabetics is strongly linked to the patient attitude, to his understanding of the disease and to his motivation to participate in the disease management. This requests permanent, long-term, intensive patient's information and education. Information tools (from oral information to website) and strategies (from usual educational courses by the diabetes care team to general public information) remain to be fully evaluated.