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Aim To describe the association between socio-economic position, health status and quality of diabetes care in people with Type 2 diabetes in France, where people may receive full healthcare coverage for chronic disease. Methods Data from a national cross-sectional survey performed in people pharmacologically treated for diabetes were used. They combined data from medical claims, hospital discharge, questionnaires for patients ( n = 3894 with Type 2 diabetes) and their physicians ( n = 2485). Socio-economic position was assessed using educational level (low, intermediate, high) and ability to make ends meet (financial difficulties vs. financially comfortable). Results People with diabetes reporting financial difficulties were more likely to be smokers (adjusted odds ratio 1.4; 95% CI 1.1-1.6) and obese (adjusted odds ratio 1.3; 95% CI 1.2-1.6) and to have poorer glycaemic control (HbA1c > 64 mmol/mol (8%); adjusted odds ratio 1.4; 95% CI 1.1-1.8), than those who were financially comfortable. They were more likely to have their diabetes diagnosed because of complications (adjusted odds ratio 1.6; 95% CI 1.3-2.0). They were also more likely to have coronary and podiatric complications (adjusted odds ratios 1.3; 95% CI 1.1-1.6 and 1.7; 95% CI 1.4-2.2, respectively). They benefited more often from full coverage (adjusted odds ratio 1.3; 95% CI 1.1-1.6), visited general practitioners more often (ratio of estimated marginal means 1.2; 95% CI 1.1-1.2) but specialists less often (adjusted odds ratio 0.7; 95% CI 0.6-0.8 for a visit to private ophthalmologist). They also felt less well informed about their condition. Conclusions Despite frequent access to full healthcare coverage, socio-economic position has an impact on the diagnosis of diabetes, health status and quality of diabetes care in France. [ABSTRACT FROM AUTHOR]

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Examines the risk factors for early death in patients with non-insulin dependent diabetes and glucose tolerance status in Paris, France. Comparison between diabetics and normoglycemic patients; Use of the Cox model in risk factor assessment; Effects of glucose tolerance decease on the median level of risk factors.

Objectif: Évaluer, en conditions réelles d’utilisation chez des patients DT2, l’efficacité, la tolérance et la maintenance de la vildagliptine. Matériels et méthodes: Une cohorte observationnelle prospective sur 2 ans a été initiée en France en 2010 à la demande de la HAS. Un échantillon représentatif de patients DT2 traités par vildagliptine a été inclus par 84 endocrinologues et 482 généralistes. Les données de suivi intermédiaire sont rapportées. Résultats: 1 470 patients sont pris en compte : 60 % d’hommes, âge moyen 63±9 ans, ancienneté du diabète 7±6,5 ans, IMC moyen=30±6kg/m2. Le taux moyen d’HbA1C était de : 7,8 %, à l’initiation de vildagliptine puis 7,1 % (N=1 080), 7,0 % (N=1 088) et 7,0 % (N=991) respectivement à 6, 12 et 18 mois. Le poids a légèrement diminué : 86 kg à l’initiation de vildagliptine puis 86kg, 85kg et 84 kg à 6, 12 et 18 mois. Le pourcentage de patients avec ASAT et/ou ALAT>120 UI était de 0,5 % avant l’initiation de vildagliptine puis 0,3 %, 0,5 % et 0,2 % à 6, 12, et 18 mois, avec des taux moyens stables : 30, 29, 28 et 27 (ASAT) et 29, 28, 28 et 27 (ALAT) à l’initiation de vildagliptine, et à 6, 12 et 18 mois. Le débit de filtration glomérulaire moyen (MDRD) était de 82 ml/min avant l’initiation de vildagliptine, puis 83, 84, et 83, à 6, 12 et 18 mois, avec un pourcentage stable (14 %) de patients avec DFG<60ml/min. Six hypoglycémies sévères sont survenues chez 6 patients sous vildagliptine (incidence=0,30/100 patient-années IC95 %=[0,12; 0,60]), toutes sont survenues chez des patients également traités par insuline et/ou sulfamide. La proportion de patients toujours traités par la vildagliptine était de 96,3 %, 92,2 % et 89,3 % à 6, 12 et 18 mois. Conclusion: La vildagliptine a montré une efficacité comparable à celle observée dans les essais cliniques et stable sur 18 mois, avec très peu d’hypoglycémies et un taux de maintenance satisfaisant. [ABSTRACT FROM AUTHOR]

Objectif: L’hypoglycémie est le principal effet secondaire de l’insulinothérapie. L’étude DIALOG avait pour objectif de déterminer la fréquence des hypoglycémies chez les patients diabétiques de type 1 (DT1) et de type 2 (DT2) insulino-traités. Cette analyse vise à identifier les facteurs prédictifs de la survenue des hypoglycémies. Patients et méthodes: DIALOG est une étude observationnelle, multicentrique, au cours de laquelle les médecins spécialistes et généralistes remplissaient un cahier d’observation et remettaient un auto-questionnaire prospectif aux patients, analysant les hypoglycémies survenues durant 1 mois de suivi. Une régression logistique multivariée a été conduite afin d’étudier l’association entre différents paramètres à l’inclusion et la survenue des hypoglycémies. Résultats: Parmi les 4424 patients inclus, l’analyse a été menée chez 912 patients DT1 et 1677 DT2 (les patients sous pompe à insuline n’étant pas dans l’analyse). Chez les DT1, les principaux facteurs prédictifs du risque d’hypoglycémie étaient les suivants : nombre d’injections d’insuline >2/jour (Odds Ratio(OR)=2,182 ; Intervalle de Confiance à 95% (IC95)=1,377 3,457), sexe féminin (OR=1,747 ; IC95=1,185–2,575), âge<65 ans (OR=1,609; IC95=1,049–2,468), IMC < 30 kg/m2 (OR=2,151; IC95=1,3003,558), durée d’insulinothérapie > 10 ans (OR=2,087 ; IC95=1,416–3,078), antécédents d’hypoglycémies globales (OR=8,625 ; IC95=4,096–18,162). Inversement, la présence de plaies chroniques du pied (OR=0,462 ; IC95=0,216–0,989) et une dyslipidémie (OR=0,565 ; IC95=0,380–0,840) étaient associées à une diminution du risque d’hypoglycémies. Chez les DT2, les facteurs prédictifs d’hypoglycémie étaient le nombre d’injections d’insuline : 2 versus 1 injection/jour (OR=1,381 ; IC95=1,038–1,837) et > 2 versus 1 injection/jour (OR=2,120; IC95=1,672–2,687), un IMC < 30kg/m2 (OR=1,309 ; IC95=1,065–1,608), une durée d’insulinothérapie > 10 ans (OR=1,596 ; IC95=1,251–2,037), des antécédents d’hypoglycémies globales (OR=3,880 ; IC95=2,767–5,440) et l’absence de coronaropathie (OR=1,436 ; IC95=1,133–1,820). Conclusion: Chez les patients DT1 et DT2, les facteurs prédictifs d’hypoglycémies sont : l’absence d’obésité (<30), la durée du traitement insulinique (> 10 ans), le nombre d’injections (>2/jour) et surtout l’existence d’hypoglycémies antérieures. [ABSTRACT FROM AUTHOR]

Objectif: Évaluer les caractéristiques, l’observance, l’efficacité et la tolérance des patients DT2 traités par la vildagliptine, en conditions réelles d’utilisation Matériels et méthodes: Une cohorte observationnelle prospective sur 2 ans a été initiée en 2010 à la demande de la HAS. Un échantillon représentatif de patients DT2 traités par la vildagliptine a été inclus par des endocrinologues et des généralistes sélectionnés aléatoirement. Les données d’inclusion sont rapportées. Résultats: 483 généralistes et 84 endocrinologues ont inclus 1 473 et 229 patients entre mai et décembre 2010. 60 % étaient des hommes, d’âge moyen 63 (± 11) ans, ancienneté moyenne du diabète 7 (± 6,5) ans et HbA1c moyenne 7,8 % (± 1,2). 45% des patients étaient obèses et 39 % en surpoids. Les patients inclus par les endocrinologues avaient un diabète plus ancien (> 5 ans pour 57 % vs 47 %) malgré un âge voisin (61,1 vs 63,4 ans), un meilleur contrôle glycémique (7% dans 39 vs 24 % des cas) et des antécédents d’hypoglycémies plus fréquents (15 % vs 9 %). Les principaux motifs d’initiation de la vildagliptine étaient : l’échec du traitement précédent (84 % pour les généralistes/72 % pour les endocrinologues), une prise de poids (17 %/18%), une diminution du nombre de prises médicamenteuses (17 %/9%), une intolérance à un traitement antérieur (12 %/10%) ou des antécédents hypoglycémiques (3,0 %/8,3%). Conformément aux précautions d’utilisation, 1 366 patients (80 %) ont eu un bilan hépatique et 1 552 (91 %) une mesure de créatininémie avant l’initiation du traitement. La vildagliptine a été rarement prescrite à des patients pour lesquels le produit n’est pas recommandé : 0,6 % des patients présentaient une élévation des transaminases > 3 fois LSN, 0,3 % une insuffisance cardiaque de stade NYHA III (aucun de stade IV) et 9,3 % une clairance de la créatinine inférieure à celle recommandée. Conclusion: La plupart des prescriptions de la vildagliptine étaient conformes au résumé des caractéristiques du produit, sans différence significative entre généralistes et endocrinologues [Copyright &y& Elsevier]

Introduction: QV et ST des DT2 conditionnent l’adhésion aux soins. Nous présentons les données de l’étude PANORAMA, évaluant QV et ST chez les DT2 en Europe. Patients et méthodes: Des patients DT2 ≥ 40 ans, diagnostiqués depuis ≥ 1 an, traités par régime seul, antidiabétiques oraux (ADO) ou insuline, ont été inclus dans 9 pays européens en s’efforçant d’obtenir un échantillon représentatif. Ils ont répondu au questionnaire ADDQoL explorant l’impact du DT2 sur QV (score de - 9 : impact négatif maximal, à +3 : impact positif maximal) et au questionnaire DTSQ mesurant ST (score de 0 : très insatisfait, à 36 : très satisfait). Résultats: 5,817 patients ont été inclus en Europe (759 en France), en 2009–2010 [femmes : 46,3%, âge : 65,9±10,3 ans (m ± sd)]. Les patients français rapportaient une altération de QV identique aux européens (ADDQoL = − 1.7±1.7 vs – 1.7±1.8), mais étaient moins satisfaits du traitement (DTSQ = 27.7±6.7 vs 29.8±6.2, p<0,05). En France, QV et ST ne différaient pas suivant le sexe alors que QV et ST diminuaient avec la durée du DT2 (p<0,05 et < 0,001 respectivement), tandis que QV s’améliorait avec le vieillissement (p<0,05), qui ne modifiait pas ST; QV et ST diminuaient avec le nombre d’ADO prescrits et plus encore avec l’insulinothérapie (p<0,001); enfin QV et ST diminuaient avec un moins bon contrôle glycémique et l’antécédent de ≥ 1 hypoglycémie sévère ou ≥ 1 épisode mensuel d’hypoglycémie légère dans l’année précédente (p<0,01 pour toutes les comparaisons). Conclusion: Il n’y a pas de différence entre la France et 8 pays européens pour QV des patients DT2, mais une moindre ST en France où QV et ST varient paradoxalement en sens inverse avec durée du diabète et vieillissement. L’intensification du traitement, en particulier l’insulinothérapie, le moins bon équilibre glycémique et les antécédents récents d’hypoglycémie s’accompagnent d’une baisse de QV et ST. [Copyright &y& Elsevier]

Introduction: Les objectifs de cette étude étaient de décrire la vision des patients ayant un diabète de Type 2 (DT2) sur leur maladie, son traitement et son suivi. Patients et méthodes: Des auto questionnaires ont été envoyés par courrier à 18 988 personnes représentatives de la population française âgées de plus de 45 ans. Le taux de réponse a été excellent (77 %) : 14 201 questionnaires ont été analysés dont 1 092 provenant de patients atteints de diabète. La prévalence du DT2 était de 7,7 % (60 % hommes ; âge moyen 66 ans ; âge au diagnostic 55 ans ; IMC : 28,9kg/m2, HbA1c moyenne : 7 %). Résultats: Quatre-vingts pour cent des diagnostics de DT2 sont faits par les médecins généralistes, 93 % des patients déclarent être suivis par celui-ci (moyenne (My) : 7 consultations/an) ; seuls 29 % ont un diabétologue (71 % des insulinés) 35 % un cardiologue et 41 % un ophtalmologiste. 77 % ont eu au moins un dosage de l’HbA1c dans les 12 derniers mois (My : 2,8 dosages). 45 % des patients ont une HbA1c < 7 %. 10 % sont sous régime seul, 73 % sous ADO seuls, 17 % sous Insuline (7 % sous insuline seule) ; (My : 4 comprimés/j pour le diabète). 61 % se plaignent d’effets indésirables liés au traitement, d’autant plus que le nombre de cps augmente (54 % en monothérapie, 69 % en bithérapie, 80 % en tri ou quadrithérapie ou sous insuline). Seuls 30 % des patients sont non observants. Ils sont plus jeunes, plus gênés (vie quotidienne, familiale, sociale, sentimentale ou sexuelle). Ils ont été diagnostiqués plus jeunes et prennent plus de comprimés, rapportent plus d’effets indésirables, ont pris plus de poids et ont une HbA1c moins bonne. Vingt pour cent des patients s’autorisent des écarts en cas de sollicitations (repas familial : 13 % ; fêtes : 8 % ; WE : 3 % ; vacances : 3 %). Les patients souhaitent un investissement et un véritable soutien de leur entourage. Conclusion: Le diagnostic et le suivi du DT2 sont faits par le médecin généraliste. Le diabétologue intervient plus tard dans la maladie, et son trôle devient prépondérant lorsque le traitement comporte de l’insuline (71 % des DT2 insulinotraités ont un diabétologue). Avec l’intensification du traitement, les patients consultent plus, ils ont davantage d’effets secondaires mais se considèrent comme observants (80 %). [Copyright &y& Elsevier]

Introduction: Les objectifs de cette étude étaient de décrire la perception du diabète de type 2 (DT2) dans un échantillon représentatif de la population française âgée de plus de 45 ans, en 2008. Patients et méthodes: Des auto-questionnaires ont été envoyés par courrier (n=18988), un excellent taux de réponses (77 %) a été obtenu : 14201 questionnaires ont pu être analysés dont 1092 réponses provenant de patients ayant un diabète. La prévalence du DT2 dans la population étudiée est de 7.7 % (avec 60 % hommes ; âge moyen de 66 ans ; âge au diagnostic : 55 ans ; BMI : 28,9kg/m2) et le taux d’HbA1c moyen : 7 %. Nous présentons ici le vécu du diabète décrit par les patients eux-mêmes. Résultats: À l’annonce du DT2 les patients sont inquiets (30 %), effrayés (13 %), en colère ou révoltés (4 %) et trouvent que c’est injuste (12 %). Quatre vingt cinq pour cent considèrent avoir besoin de plus d’informations au moment du diagnostic sur au moins un des aspects de la maladie ou de son traitement : prise médicamenteuse (49 %), risques liés au diabète (43 %), origine de la maladie (40 %), modifications de l’hygiène de vie (33 %). La moitié des patients pensent qu’il s’agit d’une maladie grave, surtout ceux inquiets à l’annonce du diagnostic, mais aussi les femmes, ceux qui ont une durée de diabète supérieure à 10 ans, ceux traités par insuline, et ceux qui sont le plus investis dans la gestion de leur maladie. 50 % des patients ont modifié leurs habitudes alimentaires, mais 71 % trouvent toujours difficile de faire une activité physique régulièrement. La famille et l’entourage sont essentiels pour la mise en place de changements de comportement durables au quotidien. Ils sont des soutiens, voire des conseillers qui facilitent le suivi des règles diététiques et d’exercice et la prise régulière des médicaments. Conclusion: Lorsque les patients prennent conscience de l’importance de la maladie, ils sont plus disposés à suivre les conseils et à les mettre en application. La famille représente un soutien fondamental pour les patients dans la prise en charge quotidienne de leur maladie au long cours. [Copyright &y& Elsevier]

Aim: This analysis estimates the prevalence of type 2 diabetes mellitus (T2DM) in French adults participating in the ObEpi (obesity epidemiology) 2012 survey and also proposes a description of that population, according to comorbidities, treatments and sociodemographic factors related to the disease., Methods: A self-administered questionnaire was posted to 20,000 households from the Kantar Health panel. In total, 25,714 adults aged≥18 years and representative of the French population completed the survey between January and March 2012., Results: The prevalence of T2DM was 5.5±0.3% (95% CI) in this representative sample of the adult French population. Average age of patients was 65.9 years; 55% were men. Mean body mass index was 29.9kg/m(2) (men: 29.4kg/m(2), women: 30.6 kg/m(2); P<0.01); the prevalence of obesity was 43.1% (men: 39.9%, women: 47.1%; P<0.01). Patient-reported treatments for comorbidities were frequent: high blood pressure, 59.1%; dyslipidaemia, 59.9%; myocardial infarction/angina pectoris, 9.7%; revascularization, 7.8%; heart failure, 7.4%; sleep apnoea, 8.3%; and osteoarthritis, 10.7%. With regards to known treatments, 81.4% of patients were taking oral antidiabetic drugs (OADs), and 15.3% were using insulin therapy. Also, 18.8% of diabetic respondents reported financial hardship., Conclusion: T2DM remains a disease of major concern: compared with the non-diabetic population, all parameters surveyed showed unfavourable ratings, particularly for women., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Aim: This study aimed to evaluate changes in the prevalence of glucose-lowering agents in a large, unselected general French population from 1997 to 2007, with specific focus on changes in other cardiovascular risk factors in relation to diabetic status during 2001-2002 and 2006-2007., Methods: The prevalence of treated diabetes was assessed in a large population who had a health check-up at the "Investigations Préventives et Cliniques" Center between 1997-2007. Baseline characteristics and risk profiles of individuals with and without treatment for diabetes were assessed and compared with data for 2001-2002 and 2006-2007., Results: From 1997 to 2007, the prevalence of treatment for diabetes increased from 0.75% to 1.73% in men and from 0.7% to 2.28% in women. In 2006-2007 compared with 2001-2002, the odds ratios for receiving glucose-lowering agents, adjusted for age, body mass index (BMI) and educational level, were 1.54 (95% CI: 1.28-1.86) in men and 1.59 (95% CI: 1.26-2.03) in women. In those treated for diabetes compared with untreated subjects, greater decreases in blood pressure, cholesterol and glycaemia were found, stress and depression scores improved, and a greater increase in BMI was found. Smoking decreased in both treated and untreated individuals. Physical activity decreased in treated individuals, but remained unchanged in the general population., Conclusion: The prevalence of people treated with diabetes increased in the Paris area. Although most concomitant risk factors decreased more in treated individuals than in the general population, physical activity and BMI worsened, thus, emphasizing the need for improving patient education., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Between 2001 and 2007, treatments for type 2 diabetes have increased and therapeutic choices have improved. However glycemic control remains insufficient. Cardiovascular risk control has widely increased. Statins, hypertensive and antithrombotic treatments are more often prescribed. Blood pressure and LDL cholesterol levels have decreased whatever age. However, progress remains possible, especially regarding blood pressure control. Obesity has increased between 2001 and 2007 to reach 41% whereas the frequency of dietetic visits has decreased. Insulin therapy (more than obesity) determines the frequency of dietetic visits: dietetic care happens too late. Important improvements of the quality of follow-up are observed. However, fundus exams and more specifically albuminuria measurement remain insufficiently performed and their progression is too slow, as well as the podiatric examination. Only 10% of people with type 2 diabetes have an endocrinology visit, which has been stable between 2001 and 2007. Information expectations of people with type 2 diabetes are strong, especially for diet. Education demand is lower but more important for people who have already benefited. This improvement of medical care leads to an increase in the cost of reimbursements. The consequences of diabetes, more than the disease itself, alter the quality of life., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Aim: This study evaluated the profiles of patients with type 2 diabetes (T2DM) to identify sets of opinions and attitudes towards the disease that might influence self-care behaviours., Methods: Altogether, 1,092 patients with T2DM, aged 45 or older from a large representative French cohort, completed a self-questionnaire exploring their knowledge and perceptions of diabetes, its impact on various aspects of daily life and self-management practices. Canonical and cluster analyses were used to identify sets of homogeneous 'profiles' of patients linking attitudes and opinions to specific disease-related behaviours (such as changes in lifestyle, drug compliance, treatment satisfaction, impact on everyday life and weight gain)., Results: Demographics of the T2DM study population were previously reported along with the main results (60% male; mean age: 66 years; mean age at diagnosis: 55 years; mean BMI: 29kg/m(2)). Five distinct patient types emerged from the typological approach: 'committed' (25%); 'carefree' (23%); 'bitter' (19%); 'disheartened' (19%); and 'overwhelmed' (15%). Each patient type defined a set of attitudes and beliefs towards T2DM that influenced disease-related behaviours, leading to different degrees of diabetes self-management., Conclusion: The DIABASIS survey provides important information for diabetes care by identifying distinct patients' profiles that express different degrees of difficulty in implementing self-management. For this reason, patients in each category require different kinds of customized support from their physician to induce behavioural changes that may be key in improving their metabolic control., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Background: A rapid increase in the prevalence of obesity has been reported in France since 1990. We investigated the impact of birth cohort on the changes in obesity prevalence after taking into account age and survey period., Methods: We analyzed data from 4 national surveys in 1997, 2000, 2003, and 2006. For each survey, self-reported data on weight and height were recorded on mailed questionnaires sent to a sample of 20,000 households, representative of the French population. Obesity was defined according to World Health Organization criteria as body mass index >or=30 kg/m. We modeled the prevalence of obesity using logistic regression with age, cohort, and period as explanatory variables. As these variables are linearly dependent, only nonlinear effects can be estimated uniquely and interpreted, after including specific chosen constraints in the models., Results: There was a progressive increase in the prevalence of obesity between 1997 and 2006, attributable either to a period effect or to a cohort effect. There was a substantial departure from a linear trend for the cohort effect only, which seemed to be stronger in women: there was an acceleration in the prevalence of obesity with birth cohort for individuals born after the mid-1960s, in both sexes., Conclusions: Our results are consistent with previous studies in other countries. Compared with older generations, men and women born in the late 1960s may have been subject to early exposures that increased their lifelong susceptibility to obesity.

Aim: The main purpose of this survey was to describe type 2 diabetes (T2DM) from the patient's standpoint in a representative French panel in 2008., Methods: Fourteen thousand two hundred and one individuals from the general population aged 45 or older completed a self-questionnaire exploring knowledge about diabetes; 1092 replies were from patients with T2DM., Results: The prevalence of T2DM in this population was 7.7%, with demographics as follows: 60% men; mean age: 66 years; mean age at diagnosis: 55 years; mean BMI: 29 kg/m(2). Eighty-five percent of T2DM patients reported that they wanted more information about at least one aspect of the disease at diagnosis; they reported feeling anxious (30%), frightened (13%), angry (4%) or that the disease was unfair (12%). Half of the patients had modified their dietary habits but 71% found it difficult to engage in regular physical activity. Most patients (90%) were treated with drugs: 81% with oral antidiabetic drugs (OAD) (44% in monotherapy) while 19% received insulin (alone or in combination with OAD). Twenty-three percent complained of weight gain since start of current therapy (average gain of 7.3 kg). Insulin initiation represented a turning point for patients who became more aware of the disease severity, more willing to follow advice and to take greater control over their disease management. The mean time from diagnosis to insulin initiation was 13.8 years. Half of the patients perceived their disease as severe especially women, patients who initially reacted with anxiety, insulin-treated patients and those actively involved in their disease management. Some gender differences emerged: women took the disease more seriously, were more engaged in self-management, and reported a higher impact on daily life., Conclusions: DIABASIS provides important information for diabetes care by highlighting patients' views of the disease, such as distress at diagnosis, lack of adequate information to cope with this distress and the important supportive role played by the family. A deeper understanding of patients' perception of the disease would help optimize customized care.

Context: In France, 43% to 63% of diabetics have an annual fundoscopy. Do the new screening tools, coupled with teletransmission of the images, allow for satisfying ophthalmological screening? It is an important matter given the foreseeable reduction in the number of French ophthalmologists in the forthcoming years., Objectives: To measure the quality of screening for diabetic retinopathy (DR), in the framework of a network, by the provision of a retinograph by numeric camera (with teletransmission of the images and centralised interpretation), in a screening centre located in town., Method: The study evaluated the quality of screening obtained in two comparable groups of general practitioners, one using the retinograph and the other using the classical method of screening by ophthalmologist. The screening was targeted at diabetics who had not had a fundoscopy in the preceding year, nor had known DR or a treating ophthalmologist (for the retinography group only)., Results: 667 patients were sampled in the retinography group (456 included) and 707 in the control group (426 included) between 1/04/02 and 1/11/02; 417 patients were followed until the end of the study in the 2 groups. A screening examination was considered effective if it was performed within the six months following its request, and by the presence of a report in the file of the general practitioner. The percentage of patients thus screened was 74% in the retinography group and 71,5% in the other group (not significant). 16% of diabetics in the retinography group had DR compared with 10% of patients in the control group. The analysis of the level of satisfaction of patients tended to show a preference for the system of screening by fundal photography., Conclusion: In the framework of a healthcare network, the availability of a retinograph by numeric camera, with the interpretation of photos by teletransmission of the images, obtained a high level of quality of screening for diabetic retinopathy that was at least as good as that obtained by a healthcare network using the classical ophthalmological screening method.

Aims: We determined the 6-year incidence of peripheral arterial disease (PAD) in a French population and assessed the association of glucose metabolism, smoking, cardiovascular risk factors and physical activity with incident PAD., Methods: Participants from the French Data from a Epidemiological Study on the Insulin Resistance Syndrome (DESIR) were studied. Participants analysed were 30-65 years (at baseline) and had complete data (n=3805) after 6 years of follow-up. Diabetes was diagnosed according to the 1999 WHO criteria on the basis of fasting plasma glucose results or previous diagnosis of diabetes mellitus. The ankle brachial pressure index (ABPI) and a claudication question were used to classify PAD., Results: The 6-year incidence of PAD (defined by ABPI<0.9 and or claudication present) among those with normal fasting glucose (NFG) and free of PAD at baseline was 5.1%. Among those with impaired fasting glucose (IFG) at baseline the incidence of PAD was 4.9% and among those with diabetes mellitus at baseline the incidence of PAD was 9.8%. The incidence of PAD among those who maintained NFG over 6 years was 4.7% and among those who progressed to diabetes over 6 years was 10.2%. Those who progressed from NFG or IFG to diabetes over 6 years were twice as likely to develop PAD compared to those who maintained NFG over 6 years, after adjustment for age and sex (OR (95% CI), 2.22 (1.12-4.42)). Independent risk factors for incident PAD using baseline population characteristics were diabetes (OR (95% CI) 2.11 (1.25-3.55)), systolic BP 122-135mmHg 1.06 (0.70-1.60), >135mmHg 1.54 (1.04-2.27) and current smoking 1.60 (1.10-2.34) after multivariate adjustment for age, sex, cholesterol, triglycerides and waist circumference., Conclusions: This French study shows that those who progress to diabetes are twice as likely to develop PAD, compared to those who maintain NFG. Peripheral arterial disease is a treatable condition and more aggressive management of atherosclerotic risk factors could reduce the numbers of people who develop PAD.

Objectives and Methods: The IDAHO 2 epidemiological survey was conducted in departments of diabetology in insulin-naïve type 2 diabetics for whom insulin was initiated. The objective was to assess the patients' profile, the treatments proposed during hospital stay and after one year., Results: 797 patients were analysed. Their characteristics were: age 64+/-12 years, 49% males, weight: 78+/-17 kg, BMI: 29+/-6 kg/m2, diabetes duration 11 years, prevalence of complications: 68%, fasting blood glucose 13+/-6 mmol/l, HbA1c: 10+/-2.2%; treatment prior to insulin comprised: at least 2 OHA: 71% of cases, one: 21%, no OAD: 8%. At hospital discharge, 54% of the patients used basal insulin. After 1 year, 670 continued on insulin. The insulin initiation was accompanied by a decrease in the FBG level (baseline: 13+/-6 mmol/l; final: 8.5+/-2.75 mmol/l; P<0.0001) and a HbA1c improvement (baseline: 10+/-2.2%; final: 7.9+/-1.4%; P<0.0001). This was observed du-ring the first 6 months (HbA1c: 7.8%, P<0.0001 versus baseline). 80% of the patients remained on the same insulin regimen after 1 year: 35% had 1 injection/day, 44% had 2, 12% had 3 and 9% had a complex regimen. The weight gain, the final daily dose and hypoglycaemias increased with the number of injections. The mean daily insulin dose was 33 U/day (24 U with 1 injection/day)., Conclusion: The IDAHO study shows that insulin is effective in type 2 diabetics however, management is inadequate with insulin therapy being initiated too late and at doses which are low after one year.

Epidemiological surveys show a large variation of type 2 diabetes (DT2) prevalence from one country to another, suggesting ethnic discrepancies in insulin sensitivity. Many data seem to confirm this hypothesis. We will show them while concentrating on data provided by surveys performed in French-speaking countries. The mechanisms of the ethnic differences in insulin sensitivity are unclear and further insights are needed. More than genetic factors, environmental factors appear to be involved in the occurence of insulin resistance and DT2. The epidemic nature of obesity and subsequent DT2 in the world urges health authorities in each country to raise campaigns to promote changes in life style and nutritional habits before the announced pandemy of DT2 becomes reality.

Purpose: To assess the relationships between lipid levels and sexual maturity, independently of age-related differences, and to investigate possible differences related to sexual maturity across the percentiles of the lipid distributions., Methods: Fasting serum total cholesterol and triglyceride concentrations were measured in 6577 boys and 6605 girls, aged from 10 to 13 years, with different Tanner stages. The total cholesterol and triglyceride mean and percentile levels were estimated according to age and Tanner stage by ordinary least squares and percentile regression models, separately in both sexes., Results: In boys and girls, total cholesterol levels were significantly associated with pubertal stage after controlling for age. At age 12, the estimated mean levels in boys varied from 4.82 mmol/L for Tanner 1 to 4.41 for Tanner 5. The corresponding values were 5.05 and 4.62 mmol/L in girls, for whom the association with maturity was stronger in the upper than in the lower percentiles (p < 0.0001); between the extreme Tanner stages, the 95th percentiles of total cholesterol differed by 0.80 mmol/L, in comparison to 0.19 mmol/L for the 5th percentiles. Therefore, 1. 8% of girls and 0.7% of boys were classified differently whether Tanner stage was used or not to assess hypercholesterolemia (concentrations in the upper 5% of the distributions). Triglycerides were positively related to sexual maturity independently of age, but the discrepancies between classifications were lower; 1.1% in girls and 0.4% in boys., Conclusions: Our findings emphasize the importance of sexual maturity, even for a given age, for interpreting lipid levels in children.

Institutions in France are not yet well prepared to respond to allegations of scientific misconduct. Following a serious allegation in late 1997, INSERM, the primary organization for medical and health-related research in France, began to reflect on this subject, aided by scientists and jurists. The conclusions have resulted in establishing a procedure to be followed in cases of alleged misconduct, and also in reinforcing the application of good laboratory practices within each laboratory. Guidelines for authorship practices and scientific assessment must also be considered. Even though each institution must remain responsible for responding to allegations of scientific misconduct within its doors, INSERM would like to see national, European, and international co-ordination about the methods of such response.

To determine the pattern of treatment of diabetes and its complications, data from a specific study performed by the French healthcare system were used. Between the 10th and 15th of May 1993, all the prescriptions for which a reimbursement was asked were registered with the age and sex of the subject for whom the prescription was written. Patients with a prescription of antidiabetic (AD) drugs were classified as diabetic. Among the 125,883 prescriptions at least one antidiabetic drug is present on 3339 (2.7%). The mean number of AD drugs prescribed is 1.3 and varies from 1 to 4. Eighty five per cent of the patients are treated with oral anti diabetic drugs alone (OAD) and 15% with insulin, alone (89%) or in association with OAD (11%). The total number of drugs (antidiabetic drugs included) prescribed for one patient varied from 1 to 18 (mean: 5.7) and is higher in women than in men. Drugs which are indicated in cardiovascular diseases (lipids lowering, blood pressure lowering drugs) are more frequent on "diabetic" prescriptions than on non diabetic ones. Most (66%) of the prescriptions are written on special forms (100% reimbursement). These forms are more often used for insulin treated patients (87%) than for non insulin treated patients (62%). Most (91%) of the prescriptions are written by a general practitioner. Taking into account the antidiabetic drugs specificity and the data base used, these results can be extrapolated to the all french diabetic population.

This 9-month pragmatic study compared 2 therapeutic regimens in the management of osteoarthritis of the hip and knee. Patients received either diacerein 100 mg/day plus standard osteoarthritic therapy for 6 months, followed by a 3-month monitoring period without diacerein, or standard therapy alone for the entire 9-month period. A total of 207 patients with osteoarthritis of the knee and hip were enrolled. Improvements in Lequense's functional index and quality-of-life scores (revised Arthritis Impact Measurement Scales Health Status Questionnaire and Nottingham Health Profile), and decreases in nonsteroidal anti-inflammatory drug and analgesic consumption were significantly greater with diacerein plus standard therapy than with standard therapy alone. The overall assessment of therapy by patients was good or excellent for 60% of those who received diacerein plus standard therapy, compared with 26% who received standard therapy alone. Medical and paramedical procedures carried out in addition to those stipulated in the protocol (medical consultations, physiotherapy, nursing, etc.), osteoarthritis-related, were fewer and less costly in the diacerein plus standard therapy group than in the standard therapy group. The average outpatient cost (in 1995 French francs) of osteoarthritis treatment in the standard therapy group was FF2272 compared with FF2360 in the diacerein plus standard therapy group. The cost-effectiveness ratios per point scored on Lequesne's index were FF1893 for the standard therapy group and FF1072 for the diacerein plus standard therapy group, leading to a saving of 43% with diacerein plus standard therapy. The marginal cost (additional cost corresponding to the clinical benefit obtained by adding diacerein to standard treatment) was FF88 per point scored on Lequesne's index.

The American Diabetes Association and a working group of the International Diabetes Federation and the World Health Organisation are considering the possibility of lowering the level of fasting glucose for diagnosis of diabetes from 7.8 mM to 7.0 mM (126 mg/dl) and adding a "hyperglycaemia" category (6.1-6.9 mM). This report studied the resulting change in the frequency of diabetes in the French D.E.S.I.R. cohort and evaluated cardiovascular risk factors according to the proposed limits. The frequency of treated diabetes was 1.0% in this cohort of more than 5,000 French men and women 30 to 64 years of age, 0.7% had a fasting glucose > or = 7.8 mM versus 1.6% for the proposed > or = 7.0 mM. Using the new criteria, 3.8% of men and 1.6% of women would be diabetic. For many cardiovascular risk factors, men with fasting glucose > or = 7.8 mM had a significantly higher risk than those in the (7.0-7.7 mM) range, whereas no significant differences were found for women. There were few differences between the (7.0-7.7 mM) and (6.1-6.9 mM) ranges, but highly significant differences were apparent for both sexes between the normoglycaemic (< 6.1 mM) and hyperglycaemic (6.1-6.9 mM) categories. The percentage of men with two or more of ten risk factors increased with fasting glucose: 36% in the normoglycaemic (< 6.1 mM) and 49% in the hyperglycaemic (6.1-6.9 mM) categories; 73% with fasting glucose in (7.0-7.7 mM) versus 90% with fasting glucose > or = 7.8 mM. In women, the corresponding percentages were lower: 26% and 60%, 32% versus 64% respectively. The major increase in cardiovascular risk factors would appear to occur at 6.1 mM, for men, whereas the increase in the combination of risk factors was at the more conservative cut-off of 7.0 mM.

Purpose: In France the low rates of death due to ischemic heart disease have been attributed to the high consumption of alcohol. However, the question remains: are the higher death rates for causes associated with alcohol consumption an explanation?, Methods: Diseases were defined according to the International Classification of Diseases, revision 9. World Health Organization data on country- and age-specific death rates were used., Results: Official causes-of-death statistics for men 40-74 years of age show that in 1990 French men under 50 years old had low death rates from ischemic heart disease but a relatively high all-cause mortality rate, in contrast to low rates for men 60 to 74 years of age. Among French men aged 40-44 years in 1960, 34% had died before reaching the age of 70-74 years. In comparison, 37% in the United States and 36% in England and Wales, had died by this age, with 4.5%, 14.1%, and 15.2% of deaths, respectively, due to ischemic heart disease. If all of the men who died early of causes associated with alcohol had died of ischemic heart disease, there would still be a lower rate in France (21%) than in the United States (26%) or in England and Wales (25%)., Conclusion: Thus, although some of the chronic heavy drinkers in France die early of causes associated with excessive alcohol consumption, this is not the only reason for the low ischemic heart disease death rates.

A national survey was performed in France from May to June, 1993. The aim of this study was to evaluate general practitioners' attitudes and behaviors when diagnosing and managing patients with lower extremity arterial disease (LEAD). One thousand general practitioners, randomly drawn from an exhaustive list, were contacted to participate in a telephone interview concerning the last patient with intermittent claudication seen in their practice. Four hundred seventy-six general practitioners participated. Risk factors noted for these 476 patients with intermittent claudication were in agreement with the literature: 86% were men aged 64 +/- 10 years (mean +/- SD) and 14% were women aged 73 +/- 8 years. Sixty-two percent had a pain-free walking distance of between 100 and 500 meters at diagnosis. Forty-five percent were former smokers and 37% currently smoked; 55% had hypertension, 14% diabetes, and 56% disturbances of lipid metabolism. A majority of them were hypercholesterolemic. The diagnosis of the disease was based primarily on a clinical assessment, confirmed for 33% by Doppler or echo Doppler. The mean duration of diagnosis was 4.4 +/- 4.1 years. Management of the disease was mainly by prescription of vasodilators (91%), antiplatelet agents (59%), and anticoagulants (8%). Use of Doppler or echo Doppler was recommended once a year. Infection was observed in 27% of patients. Thirty-eight percent had had a cardiac incident (angina pectoris or myocardial infarction) and 10% a cerebrovascular accident. They differed significantly from those with LEAD alone for the following parameters: age (68.5 +/- 9.2 vs. 63.2 +/- 10.3 years; p < 0.001); duration of LEAD (5.6 +/- 4.6 vs. 3.6 +/- 3.5 years; p < 0.001); hypertension (65% vs. 50%; p < 0.01); and current smoking (29% vs. 43%; p < 0.01). This survey confirmed the feasibility of telephone interviewing, on a large sample of general practitioners in France. The high level of association with other cardiac incidents was, for these patients, a much higher risk of mortality and morbidity than LEAD alone. It would be interesting to validate the associations observed with a prospective study of comorbidity.

Purpose: Medical knowledge regarding chronic illness has increased in recent years. Critical gaps in our understanding of the educational factors necessary to change the clinical aspects of most diseases remain. The role of the general practitioner, the primary care provider, in the delivery of educational interventions has not been clearly defined., Methods: For the first phase in the educational diagnosis of Type 2 diabetic patients treated by general practitioners in France, a stratified random sample of 8% of general practitioners was drawn; 70% agreed to be interviewed., Results: Demographic characteristics of physicians were comparable with previous studies. Physicians accepted the seriousness of the disease. 75.9% devoted at least as much time to the psychological as to the somatic aspects of the disease. 74.7% reported using a co-active approach with patients, permitting the use of more innovative educational strategies. Logistic regression analysis indicated that the ages of the physicians and patients, inclusion of the family, the number of patients seen, and the perception of patients as compliant were predictive of the co-active approach., Conclusions: The overwhelming proportion of physicians who use the co-active approach was the single most important factor in the development of an educational intervention where the general practitioner serves as the primary, continuous reinforcer for long-term behavior change. This program is currently being tested in a randomized clinical trial among general practitioners in France.

The prevalence of diabetes is known to be high in the West Indies, whereas CVD seems relatively rare. This apparently contradicts the existence of the insulin-resistance syndrome, a cluster of metabolic abnormalities supposedly favoring both diabetes and cardiovascular complications. To address the question of whether this contradiction could be accounted for by specific features of this syndrome, we compared 1505 Caucasian and 181 Afro-Caribbean men, all participants in the French Telecom Study. The Afro-Caribbeans were of the same age and had the same BMI as the Caucasians; they also had significantly higher subscapular skin-fold thickness and fasting insulin level, but similar BP and blood glucose level, and significantly lower plasma triglyceride level. Thus, although some features of the insulin-resistance syndrome were present (central adiposity and high insulin levels), none of the associated metabolic abnormalities were present. However, within the Afro-Caribbean group, subjects with plasma insulin concentrations above the median (> 52 pM) had higher mean BP and glucose and triglyceride levels compared with subjects with insulin concentrations < or = 52 pM (P < 0.001). After adjustment for age and BMI, these differences, though smaller, still were statistically significant. These findings confirm that higher insulin concentrations are associated with higher levels of potentially atherogenic and diabetogenic metabolic parameters. However, depending on ethnic origin, the mean levels of these parameters seem to be different, with the consequence that, even if they are elevated with increasing insulin levels, they may not reach values high enough to determine a substantial risk of disease.

Data from a national survey of private medicine in France were used to estimate the frequency of diabetes in primary care and to analyse both patient characteristics and therapeutic management. An approach was made to 2012 physicians who were requested to complete a questionnaire for each patient they saw during the course of a single day; 1103 responded and completed more than 20000 questionnaires. An additional investigation looked into the nature of the non responders. Diabetics represent 2,2% of patients in private medicine. Each year about 5,5 million consultations in private practice in France are for diabetes alone or for diabetes in association with other illnesses. 89% of diabetic patients are over 45 years of age and more than 48% older than 65. In most cases (80%), diabetes is associated with other medical problems, half of them being consequences of diabetes (cardio-vascular diseases, ocular and renal diseases). In 85% of cases, diabetics receive their basic care from a general practitioner. Therapeutic management is based mainly on drugs; diet or advice about life style are mentioned in barely one third of cases. Using linkage with social security data, it was possible to make a crude estimate of the number of diabetics in France. It was estimated at about 1 million for 52,6 million inhabitants.

Within an economic framework it is possible to evaluate the direct cost of diabetes. In 1984, for 109 diabetics - 27 insulin-dependent patients (IDD) and 82 non-insulin-dependent patients (NIDD) - of the Paris area, the average cost of diabetes was 7711 francs (Fr) for the IDD and 5892 Fr for the NIDD. This cost is the sum of the medical visits, drugs and hospitalization. The medical expenditures of the NIDD is roughly the same as for the general population (6462 Fr). For the IDD, the main difference concerns the drug expenditures. Moreover, in 1984, there is more home-care than in 1978. Lastly, there is little difference between prescription use in the U.S. and in France. Such results allow us to discuss the reimbursement of the care needed for diabetics.

A retrospective study of adult congestive cardiomyopathy was carried out; the admission criteria being heart failure with cardiomegaly after the exclusion of known causes of heart failure. Coronary artery disease was excluded by forming two sub groups, one with proven normal coronary arteries at angiography or autopsy and the other with only assumedly normal coronary arteries. The results concern the study of the incidence of this disease which has been regularly seen over the last 10 years in departments with a large number of referrals of cardiomyopathy. --Professional factors are analysed to see if there is a higher incidence amongst the working classes. --Other factors are analysed by comparison with three control groups: normal, coronary and valvular disease, and diabetes which may be a predisposing factor, but not the serum cholesterol which is decreased in these patients. There is a significant association with smoking and alcoholism and the main biological sign of the latter condition, macrocytosis. This is also found in both coronary sub groups. The isolation of this alcohol factor in the genesis of congestive cardiomyopathy implies the possibility of reversing or stabilising the myocardial damage after its withdrawal, so changing the severe diagnosis associated with this disease.

Successful patient education requires planed programs with specific target populations. As general practitioners see 85% of noninsulin-dependent diabetics in France, this study was designed to test the feasibility of the telephone as a method for data collection within the context of a random sample of general practitioners in the Paris region. In addition, data were collected assessing physician's perceptions of various barriers and facilitators to the management of this illness. The study demonstrated the feasibility of phone interviews among general practitioners, as no significant differences were found in response rates or for any single variable collected on the telephone versus "face-to-face". Treatment patterns were described and results indicated that 77% of general practitioners agreed to participate in a subsequent study and, of these 93% agreed to the participation of their noninsulin-dependent patients.

The importance of diabetes in France was estimated on the basis of drug sales data from 1976 to 1982. In 1982, 1.1% of the French population was taking oral hypoglycaemic agents daily, and 0.2%, insulin. These results are compared with the prevalence of diabetes (1.9%) estimated in a 1976 French epidemiologic study carried out on a random sample of practitioners, and other European estimates. The particularly high consumption of oral antidiabetic agents in France is then addressed, in relation to diagnosis and prescription habits.