Compliance and Control in Insulin-Dependent Diabetes: Does Behavior Really Make a Difference?
Suzanne Bennett Johnson University of Florida Health Science Center
Pancreatic beta-cell destruction and the resultant inability of the pancreas to produce insulin is the pathological process underlying insulin-dependent diabetes mellitus (IDDM). Because insulin insufficiency is the underlying cause of this disease, treatment involves insulin replacement by injection once or twice a day. Exogenous insulin replacement prolongs life, but only crudely approximates normal pancreatic function. Although the goal of treatment is to maintain the patient's blood glucose within the normal range, blood glucose excursions readily occur in response to eating, exercise, illness, and stress. Consequently, the management of this disease requires a complex array of daily insulin injection, dietary, and exercise behaviors. In addition, the patient is taught to conduct multiple blood glucose tests to monitor current health status and to take appropriate action should significant blood glucose excursions occur.
IDDM is only one form of diabetes. Also known at Type I diabetes, onset typically occurs in childhood. Consequently, it is commonly referred to as juvenile or childhood diabetes. IDDM has no cure; children diagnosed with this disease remain diabetic throughout their lives. Hence, IDDM is a disease of both childhood and adulthood.
Most adult diabetics, however, suffer from noninsulin-dependent diabetes mellitus (NIDDM), also known as adult or Type II diabetes. When discussing the prevalence of IDDM, it is common to compare it with the prevalence of NIDDM. This comparison makes the problem of diabetes in children appear small because only 5% of all persons with diabetes in the United States have the juvenile form of the disorder. However, if one compares IDDM with other chronic diseases of childhood, a different