[Challenges and future perspectives of healthcare networks].

Healthcare networks play a central role in the French healthcare system. A reflection on their future and the evolutions to be envisaged is currently in progress. Moreover, the French Directorate General for Healthcare Provision should soon publish a methodological guide concerning these networks.

Improving diabetes management with electronic medical records.

Most primary-care physicians have adopted electronic medical records (EMRs) for the management of patients in ambulatory care. Observational trials suggest that the use of EMRs improves the achievement of the recommended standards of diabetes care and intermediate outcomes. A French group of general practitioners has shown, in a randomized controlled trial of diabetes care, the beneficial effects of a follow-up module integrated into an EMR.

Insulin therapy for diabetes mellitus: treatment regimens and associated costs.

Aims: To describe insulin therapy in patients with diabetes, to determine treatment costs and to compare costs among treatment regimens.

Methods: This observational study was performed by 734 French pharmacists. Adult patients filling an insulin prescription were invited to participate.

Can postprandial blood glucose excursion be predicted in type 2 diabetes?

Objective: We investigated the relationship between carbohydrate intake and postprandial blood glucose (BG) levels to determine the most influential meal for type 2 diabetic subjects treated with basal insulin and needing prandial insulin.

Research Design And Methods: Three-day BG profiles for 37 type 2 diabetic subjects, with A1C levels of 7.7%, treated with sulfonylurea and metformin, and well titrated on insulin glargine, were analyzed using a continuous glucose monitoring system.

Feasibility of screening for silent myocardial ischaemia according to the ALFEDIAM-SFC 2004 Guidelines in a population of diabetic patients.

Background: Screening tests have to meet a number of criteria, including feasibility. The aim of this study was to estimate the proportion of the French diabetic population that is eligible for screening for silent myocardial ischaemia (SMI), and to evaluate the feasibility of such screening in the Franche-Comté region.

Methods: Data were taken from the Echantillon National Témoin Représentatif de la Population Diabétique (ENTRED, a Representative National Sample of the Diabetic Population 2001 study), which was based on questionnaires filled out by 3646 diabetic patients.

Sexual activity in diabetic patients treated by continuous subcutaneous insulin infusion therapy.

Background And Aims: As concerns over interference with sexual activity may be an obstacle to initiating pump therapy in diabetic patients, the aim of the study was to assess the impact of continuous subcutaneous insulin infusion (CSII) therapy on sexual activity.

Patients And Methods: Patients filled out a questionnaire on their demographic data, diabetes history, pump-treatment history, metabolic control, inconvenience/convenience of the pump and catheter, and information on sexual activity.

Results: A total of 271 diabetic patients (aged 44+/-17 years, 51% women, 22% single), treated with CSII for 4.

Real-life application and validation of flexible intensive insulin-therapy algorithms in type 1 diabetes patients.

Aims: Flexible intensive insulin therapy (FIT) has become the reference standard in type 1 diabetes. Besides carbohydrate counting (CHO), it requires the use of algorithms to adjust prandial insulin doses to the number of CHO portions. As recourse to standard algorithms is usual when initiating FIT, the use of personalized algorithms would also allow more precise adjustments to be made.

Prevalence of macrovascular complications and cardiovascular risk factors in people treated for diabetes and living in France: the ENTRED study 2001.

Aim: The aim of this study is to estimate the prevalence of macrovascular complications and cardiovascular risk factors among people with diabetes living in France and to compare these prevalences with other national estimates.

Methods: We randomly sampled 10,000 people who received one or more reimbursements for insulin or oral hypoglycaemic treatment from the major national medical insurance system during the period October-December 2001; 3646 of the 10,000 people completed a questionnaire; for a subgroup of 1718 people, their care providers completed a medical questionnaire.

Results: The prevalence of diagnosed macrovascular complications was of 17% according to patients (angina or myocardial infarction, 15%; coronary revascularization, 9%) and of 20% overall, according to physicians (angina or myocardial infarction, 16%; coronary revascularization, 6%; stroke, 5%).

French medical practice in type 2 diabetes: the need for better control of cardiovascular risk factors.

Aims: In type 2 diabetes (T2D), to describe treatments to prevent cardiovascular disease, to compare current practice to French guidelines, and to identify factors associated with recommended treatments.

Methods: In the Echantillon National Témoin Représentatif des Personnes Diabétiques (ENTRED) study, 10,000 adults treated for diabetes (any type) were randomly selected from the French National Health Insurance System database. Deliveries during the last quarter of 2001 of treatments to prevent cardiovascular disease were extracted.

Should postprandial hyperglycaemia in prediabetic and type 2 diabetic patients be treated?

Numerous prospective studies support the concept of postprandial glycaemia (PPG) as a risk factor for cardiovascular diseases (CVDs) in individuals with impaired glucose tolerance (IGT). A meta-analysis has demonstrated an exponential relationship between 2-hour postchallenge glucose levels and the incidence of CVD. This relationship is stronger than those observed with fasting glycaemia or glycosylated haemoglobin (HbA(1c)), and persists after adjustment for other vascular risk factors.

Improving glycaemic control of patients with Type 2 diabetes in a primary care setting: a French application of the Staged Diabetes Management programme.

Aims: To assess the impact of a French adaptation of the Staged Diabetes Management (SDM) programme on glycaemic control of people with Type 2 diabetes in primary care. Secondary endpoints were blood pressure, blood lipids, healthcare costs and quality of life.

Methods: Prospective, randomized controlled study, of 1 years' duration.

Sulfonylureas and cardiovascular effects: from experimental data to clinical use. Available data in humans and clinical applications.

Objectives: 33 years after the UGDP study, the question of deleterious effects of the sulfoylurea (SU) is still raised. We have made a systematic review of the literature from experimental studies to clinical and epidemiological studies.

Results: The main molecule studied is glibenclamide (GB).

Effects of clinical audit on the quality of care in patients with type 2 diabetes: results of the DIABEST pilot study.

Objective: To improve the quality of diabetes care in general practice by the use of audit.

Material And Methods: A prospective multicenter pilot study. Thirty-five groups of ten general practitioners (GPs) have been set up throughout France on a voluntary basis.

[Silent ischemic cardiopathy: which diabetics to examine?].

Non-Invasive coronary investigations are positive in 12 to 52% (average 22%) of type II diabetics, and 11 to 30% (average 17%) of type i diabetics. These statistics vary according to bias of recruitment. Haemodynamic lesions are found at coronary angiography in 35 to 80% of patients who have at least one positive non-invasive investigation.

Management of drugs affecting blood glucose in diabetic patients with renal failure.

Prevention of the onset or worsening of microalbuminuria by good blood glucose control has been confirmed in Type 2 diabetes, though not at the stage of chronic renal failure (CRF). Thus, it would seem desirable to maintain strict blood glucose control whenever circumstances allow. If prescribed sulphonylureas (SU) are effective, they can be continued at adjusted doses until an advanced stage of CRF, subject to strict monitoring.

The Pro115Gln and Pro12Ala PPAR gamma gene mutations in obesity and type 2 diabetes.

Objective: Peroxisome-proliferator-activated receptors gamma (PPAR gamma), is a key regulator of adipocyte differentiation and energy balance. Two naturally occurring mutations in the PPAR gamma gene, Pro115Gln and Pro12Ala, have recently been shown to impair the function of the PPAR gamma2 isoform of the receptor and to be associated with obesity or diabetes-related phenotypes in different populations.

Subjects: We studied the occurrence and possible associations of the Pro115Gln and Pro12Ala in the PPAR gamma2 gene with several clinical and metabolic phenotypes in three independent large populations of non-obese non-diabetic, type 2 diabetic, and morbidly obese French Caucasians.

Cooperation between general practitioners and diabetologists and clinical audit improve the management of type 2 diabetic patients.

A programme was set up in the Essonne (France) between 1994 and 1998 to improve the quality of care for Type 2 diabetic patients. A consensus panel of general practitioners and diabetes specialists established guidelines based on the French St. Vincent recommendations.

[Role of beta blockers as the only therapy for preparing the hyperthyroid patient for surgery].

Indications and contraindications of the beta blocking drugs are reviewed as a method of preparation to sub total thyroidectomy in thyrotoxicosis. They allow a shorter preparation's time: a few days, until one or two weeks maximum. Major risks are cardiac failure, and altered response to stress.