Intensive Insulin Therapy: A Personal and Historical Perspective

Intensive therapy of Type I diabetes is a system of therapy in which the patient is the key partner in day-to-day management. A number of technical developments in the late 1970s led to the development of intensive therapy. Self-monitoring of blood glucose (SMBG) proved to be the major change agent that stimulated the revolution in diabetes management that is intensive therapy. One important event that stimulated widespread use of SMBG was the development of spring-loaded finger-pricking devices. The introduction of glycated hemoglobin measurements as an indicator of glycemic control over several weeks allowed quantitative assessment of glycemic control. The advent of continuous subcutaneous insulin infusion (CSII) stimulated thinking about insulin regimens. These advances have combined not only to facilitate development of intensive therapy as a strategy of diabetes management, but also to permit development of research protocols to assess the impact of such therapy on the chronic complications of diabetes.