JOHANNA SHAPIRO, Ph.D., DUNCAN WIGG, M.S., M. ARTHUR CHARLES, M.D., Ph,D., AND MICHAEL PERLEY, M.D.
Self-monitoring of blood glucose (SMBG) and portable insulin infusion pumps (PIIP) have proven effective in improving the metabolic control of insulin-dependent diabetes, Early data also suggest SMBG and/or PIIP efficacy in the reversal of mild chronic diabetic complications and reduction of neonatal mortality. However, of concern to physicians and investigators has been the potential negative psychological consequences of PIIP use. For example, a portable pump worn externally may threaten a patient’s self-esteem as he becomes increasingly anxious about others’ awareness of his disease. Second, the patient might become depressed and/or anxious because of the greater decision-making responsibility inherent in using SMBG and portable pump devices. Third, SMBG and a portable pump both may function as a constant reminder of diabetes to the patient, which could also increase levels of depression and anxiety, as well as threaten self-esteem. Finally, the personal changes required of the patient using PIIP technology could have a negative effect on the family environment by disrupting family function, altering family roles, etc.