Diabetes Mellitus is a serious metabolic disorder that places patients at increased risk of coronary and vascular disease, as well as debilitating conditions such as retinopathy, nephropathy, and neuropathy (Table-1)(1-4). The attainment of tight glucose control can reduce the occurrence of deleterious long-term complications associated with the progression of both type1 and type2 diabetes mellitus. (5-10) This relationship has been most convincingly demonstrated with microvascular complications (i.e., retinopathy, neuropathy, and nephropathy).

In the Diabetes Control and Complications Trial (DCCT), intensive therapy reduced the overall risk of developing microvascular complications by 60% in-patients with type 1 diabetes mellitus. (5) The United Kingdom Prospective Diabetes Study (UKPDS) showed a 25% risk reduction in microvascular endpoints with intensive therapy for type 2 diabetes, (9) and every 1% decrease in HbA1c correlated with a 37% reduction in the risk of microvascular complications. (11) Data are less definitive for macrovascular complications such as coronary heart disease and peripheral vascular disease, but current evidence suggests that hyperglycemia is associated with negative cardiovascular outcomes.(11-13) In turn, improved control of blood glucose can reduce the costs associated with the treatment and long-term management of the common complications of diabetes. In the DCCT, the annual cost of therapy aimed at intensive control was approximately threefold the cost of conventional therapy but it was estimated that intensive treatment would begin to show savings within 5-7 years by decreasing the incidence of future complications. (14)

Limitations of intensive therapy

In order to achieve strict metabolic control, however, patients must monitor their blood glucose levels repeatedly during the day and adapt their insulin therapy accordingly. Insulin injections have become easier and less painful to administer. Intensive insulin therapy in the DCCT was given by insulin pump or at least three insulin injections per day guided by finger-prick glucose determinations.

It is recognized that self-monitoring of blood glucose (SMBG) can play an important role in achieving and maintaining glycemic control, especially for type1 diabetes patients and insulin-using type 2 diabetes patients. (15-17) Current American Diabetes Association (ADA) guidelines recommend SMBG testing at least three to four times each day in patients with type 1 diabetes and at least once a day in patients with type 2 diabetes who cannot be managed with diet and exercise alone. (18) In fact, even highly motivated patients with type 1 diabetes probably only perform one or two spot determinations of blood glucose per day. Thus, maintaining blood glucose levels within the target range can be an elusive goal especially in the paediatric population. Varying and unpredictable physical activity and eating habits, combined with some young patient's reluctance to undergo or perform glucose testing, lead to a high risk of hypoglycemia for this group. In addition, current methods for SMBG have limitations, especially for detection of nocturnal hypoglycemia, and may be misleading, due to monitor accuracy problems or patient errors in monitoring technique.

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