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The burden of hypoglycaemia is important, particularly in elderly type 2 diabetes (T2D) patients. Unfortunately, however, few studies are available concerning this population. GERODIAB is a prospective, multicentre, observational study that aims to describe the 5-year morbidity and mortality of 987 T2D patients aged 70 years and older. After analyzing the frequency of and factors associated with hypoglycaemia in the 6 months prior to study inclusion, it was found that hypoglycaemia was associated with retinopathy, lower levels of LDL cholesterol and altered mini-Geriatric Depression Scale (GDS) scores.

Insulin pump therapy is an emerging option in the management of type 1 diabetes (T1D), but it often remains unused. For this reason, in 2007, a French national survey was carried out to update the frequency of insulin pump use in the paediatric population compared with a previous survey done in 2001.The present survey was performed in hospital departments involved in paediatric diabetes management (n = 67) and in adult departments involved in adolescent diabetes management (n = 113). The number of T1D children (age18 years) treated in each department, with or without the use of an insulin pump, and the number of insulin pump therapies initiated during the previous year were collected.A total of 60 paediatric and 28 adult centres responded, involving 9073 T1D children and adolescents (93% in paediatric departments). Of these patients, 1461 (16%) were treated by insulin pump, 89% of which were managed in paediatric centres. However, pump use was more frequent in adult than in paediatric centres (32% versus 18%, respectively). Also, 38% of insulin pumps were initiated during the year prior to the survey. In addition, in 2001, 140 children were treated with insulin pump in 13 paediatric centres (versus 56 centres in 2007).The number of centres using insulin pump therapy for diabetic children and the number of children treated by insulin pump were increased fourfold and 10-fold, respectively, from 2001 to 2007, indicating greater access to pump therapy in the French paediatric population. The present survey is still ongoing to evaluate the decision-making criteria that influence the initiation of insulin pump therapy in T1D paediatric patients.

To determine the utility of the continuous glucose monitoring system (CGMS) as an outpatient procedure to improve management of diabetes in adolescents.Twelve adolescents (mean age: 16.2 +/- 3 years) with poorly controlled type 1 diabetes (HbA(1c)8%) were included in this trial. Mean HbA(1c) during the previous year was 10.1 +/- 1.2%. Insulin treatment consisted of 2 or 3 daily injections in 10 cases and CSII in 2. At the beginning of the study, HbA(1c) was determined and low blood glucose index (LBGI) was calculated. Continuous glucose monitoring was performed for three days. After downloading and analyzing data, results were discussed with the patient and insulin treatment was adjusted. Two months later testing was repeated and all parameters were reassessed.Initial CGMS profiles demonstrated glycemic excursions unrecognized by capillary measurements in all twelve patients. Glycemia before and after meals varied from60 mg/dL to200 mg/dL in 2 patients (2 episodes). Postprandial hyperglycemia exceeded 200 mg/dL in 10 patients (24 episodes). Prolonged overnight hyperglycemia was observed in 5 patients (7 episodes), dawn phenomenon in 4 patients (6 episodes) and nighttime hypoglycemia in 4 patients (4 episodes). A day-to-day reproducibility of glycemic profiles was observed in 8 patients. Then insulin treatment was adjusted according to CGMS data. Changes involved dose levels in 3 patients, insulin type in 7, number of injections, i.e. 3 instead of 2, in 5 or change from insulin injection to CSII in 1. Reassessment two months later demonstrated a significant reduction of glycemic excursions in 8 patients. HbA(1c) (m +/- SD) decreased from 10.3 +/- 2.1% to 8.75 +/- 1.06% (p0.05). LBGI increased from 1.7 +/- 0.9 to 2.4 +/- 1.4 but the difference was not significant.Use of CGMS in diabetic adolescent outpatients achieved a significant improvement in metabolic control not only by providing accurate data for adjustment of insulin treatment but also by promoting patient communication and motivation.

Summary The development of implanted insulin pump treatment has been particularly intense in France and French implanting centers joined to form an association called EVADIAC. The data collected by EVADIAC have clearly documented benefits as well possible problems with this treatment mode. In comparison with SC administration, intraperitoneal (IP) insulin infusion via an implanted pump achieves good metabolic control, improves long-term stability of diabetes and significantly reduces the risk of severe hypoglycemia. Problems can involve pump slowdown, catheter obstruction or local complication at the implantation site. With respect to the benefits, the rate of complications is highly acceptable. However, amongst the implanted diabetic patients, some elect to give up such a treatment mode. In a retrospective study we intended to examine their reasons for giving up this treatment. In our center, the patients who elected by themselves to give up the implanted pump account for 16% of all treated patients. This group of patients did not have, as compared to other implanted patients, less benefits nor more restrictions or incidents that could have impaired their well being. The reasons for giving up the implanted pump seem more often to be related to the refusal of a strict and institutional management linked to this treatment.

Objectif Suite a l’enquete francaise realisee en 2007, la phase 2 sur les pratiques d’initiation du traitement par pompe en pediatrie a ete menee entre juin 2008 et sept. 2009 afin de decrire les modalites de mise en route d’un traitement par pompe (MRP) a insuline chez les enfants ( Resultats 54 diabetologues hospitaliers de 41centres de pediatrie et 13 centres de diabetologie adulte ont inclus 207 enfants DT1 âges de 11 ± 4 ans (de 8,2 mois a 18 ans), dont 52 % de garcons. L’anciennete du diabete est de 4 ± 3 ans a la MRP (de 0 a 14,7 ans). 20 % des patients ont presente une hypoglycemie severe et 17 % une acidocetose dans les 12 mois precedant la MRP. L’insulinotherapie avant la pompe est de 1 ± 0,6 U/kg/jour avec 3,2 ± 0,6 injections (69 % par stylo) ; 38 % des patients realisaient des injections ponctuelles supplementaires. La derniere valeur de l’HbA1c est comprise entre 8 et 10% pour 44% des patients, 10 % pour 16 %, pour une moyenne generale de 8,8 ± 2 %. Les patients font 4,5 ± 1,6 glycemies capillaires par jour et declarent 6,7 ± 8,6 hypoglycemies non severes par mois. La mise en route de la pompe utilise preferentiellement un analogue rapide de l’insuline (90 %) avec catheter a canule souple (95 %). Le debit de base est de 15 ± 12 U/24 h avec un rapport basal/total de 41,6 ± 14 %. La pompe est principalement motivee par la demande de l’enfant (61 %) ou de ses parents (46 %), l’equilibre insuffisant du diabete (46 %), la phobie des injections (28 %) et par un phenomene de l’aube (10 %). Pour 12 % des enfants la pompe constitue l’insulinotherapie de 1re intention (âge median 5 ans, de 8,2 mois a 15,2 ans). En moyenne 2 mois apres la MRP, l’HbA1c est de 7,9 ± 0,8 % amelioree significativement de -1,2 ± 2,0 % (p Conclusion Le nombre d’enfants diabetiques traites par pompe a insuline a ete multiplie par 10 durant les 6 dernieres annees. Cette premiere cohorte de 200 enfants DT1 souligne le contexte et les specificites des indications de la pompe en pediatrie en France (âge, taux d’HbA1c, reduction des hypoglycemies). La prise en compte des demandes de l’enfant et de ses parents semble aujourd’hui plus determinante.

Introduction Le traitement par pompe a insuline chez l’enfant diabetique de type 1 (DT1) s’est developpe dans de nombreux pays ces dernieres annees. Le but de l’enquete est de reactualiser l’utilisation du traitement par pompe chez l’enfant et l’adolescent en France par comparaison avec la derniere enquete menee en 2001, 1 an apres le remboursement. Materiels et methodes L’enquete nationale menee en 2007 a porte sur 66 services de pediatrie francais et 100 services de diabetologie pour adultes. Resultats Cinquante-sept services de pediatrie ont repondu (de 32 CHU et 25 CH de toutes les regions de France) qui assurent le suivi de 8257 enfants et adolescents ( Conclusion L’enquete portant sur un tres large echantillon d’enfants et adolescents DT1 Francais (plus de 50 % la population nationale estimee) indique l’augmentation tres importante en 6 ans de l’utilisation du traitement par pompe en pediatrie, atteignant en moyenne 15 % des files actives de DT1. Les programmes de formation menes, l’obtention d’un remboursement et une organisation des soins, ont permis de faire face aux obstacles et d’ameliorer l’acces au traitement par pompe pour les enfants et adolescents en France. L’etude se poursuit afin d’evaluer plus precisement les indications et modalites du traitement par pompe en pediatrie.

Self-monitoring of blood glucose started only fifty years ago. Until then metabolic control was evaluated by means of qualitative urinary blood measure often of poor reliability. Reagent strips were the first semi quantitative tests to monitor blood glucose, and in the late seventies meters were launched on the market. Initially the use of such devices was intended for medical staff, but thanks to handiness improvement they became more and more adequate to patients and are now a necessary tool for self-blood glucose monitoring. The advanced technologies allow to develop photometric measurements but also more recently electrochemical one. In the nineties, improvements were made mainly in meters' miniaturisation, reduction of reaction time and reading, simplification of blood sampling and capillary blood laying. Although accuracy and precision concern was in the heart of considerations at the beginning of self-blood glucose monitoring, the recommendations of societies of diabetology came up in the late eighties. Now, the French drug agency: AFSSAPS asks for a control of meter before any launching on the market. According to recent publications very few meters meet reliability criteria set up by societies of diabetology in the late nineties. Finally because devices may be handled by numerous persons in hospitals, meters use as possible source of nosocomial infections have been recently questioned and is subject to very strict guidelines published by AFSSAPS.