[Clinical development of unstable (brittle) diabetes mellitus, its therapy and prognosis]

Treatment of labile (brittle) diabetes characterized by variations of the blood sugar level, liability to develop ketoacidosis and in susceptible subjects the development of organ complications, was always a serious problem. The objective of the present work is to evaluate the results of a long-term study concerned with the relationship of compensation, vascular and neurological complications of labile insulin-dependent diabetics. The authors investigated indicators of compensation, and in collaboration with an ophthalmologist, and neurologist also signals of possible damage of the eye, central and peripheral nerves, kidneys. The results achieved by treatment were evaluated systematically. Consistent with the actual situation, treatment with conventional insulin or less common regimes were selected, and the authors reacted also to findings pertaining to organ complications. The cause of lability was assessed and eliminated. During the average period of treatment of 10.6 +/- 2.7 years a significant (p < 0.001) drop of glycated haemoglobin occurred from the baseline value of 12.3 +/- 2.5% to 8.8 +/- 1.3%. The development of organ complications can be influenced favourably to certain extent in particular by satisfactory control of diabetes during the first 10 years of the disease. Treatment is ensured in collaboration with a neurologist, ophthalmologist and indicators of glomerular and tubular kidney function are monitored. The assumption was confirmed that at present it is possible to treat successfully labile (brittle) diabetes and eliminate deteriorating the life of diabetics.