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Management strategies for brittle diabetes
1Endocrinology and Metabolism Department/ERIT-M0106, Lille University Hospital, 6 Rue du Pr Laguesse, 59037 Lille Cedex, France. mc-vantyghem@chru-lille.fr
Annales D'Endocrinologie
|October 31, 2006
Summary
Brittle diabetes, affecting 3/1000 patients, causes severe life disruption and poor outcomes. Management involves treating underlying causes and optimizing insulin therapy, with islet transplantation as an option for severe cases.
Area of Science:
- Endocrinology
- Metabolic Disorders
Background:
- Type 1 diabetes is inherently unstable, but "brittle diabetes" signifies life-disrupting instability.
- Affects 3/1000 insulin-dependent diabetic patients, predominantly young women, with poor prognosis.
Purpose of the Study:
- To define brittle diabetes, its causes, assessment methods, and therapeutic strategies.
- To explore advanced treatment options like islet transplantation.
Main Methods:
- Review of literature on brittle diabetes causes and clinical presentation.
- Discussion of quantitative measures for blood glucose variability (MAGE, MODD, LI, LBGI, Clarke's score, Hyposcore, CGM).
- Outline of therapeutic approaches including optimizing insulin therapy and considering islet transplantation.
Main Results:
- Identified causes: malabsorption, drugs, defective insulin, hormonal defects, delayed gastric emptying, and psychosocial factors.
- Quantification of instability is crucial for assessment.
- Therapeutic strategies focus on underlying causes, optimized insulin therapy (analogues, CSII), and potentially islet transplantation.
Conclusions:
- Brittle diabetes requires a multifaceted approach addressing organic, psychosocial, and glycemic control aspects.
- Isolated islet transplantation offers a potential solution for severe hypoglycemia unawareness and lability under specific conditions.
- Continuous Subcutaneous Insulin Infusion and islet transplantation represent advanced options for refractory cases.
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