Factors associated with psychological and behavioral functioning in people with type 2 diabetes living in France

<p>Abstract</p> <p>Background</p> <p>To identify demographic and clinical factors associated with psychological and behavioral functioning (PBF) in people with type 2 diabetes living in France.</p> <p>Methods</p> <p>In March 2002, approximately 10,000 adults, who had been reimbursed for at least one hypoglycemic treatment or insulin dose during the last quarter of 2001, received a questionnaire about their health status and PBF (3,646 responders). For this analysis, the 3,090 persons with type 2 diabetes, aged 18-85 years old were selected.</p> <p>PBF was measured with the adapted version of the Diabetes Health Profile for people with type 2 diabetes. This permitted the calculation of three functional scores - psychological distress (PD), barriers to activity (BA), and disinhibited eating (DE) - from 0 (worst) to 100 (best).</p> <p>Results</p> <p>Major negative associations were observed with PBF for microvascular complications (a difference of 6.7 in the BA score between persons with and without microvascular complications) and severe hypoglycemia (difference of 7.9 in the BA score), insulin treatment (-8.5 & -9.5 in the PD & BA scores respectively, as compared to treatment with oral hypoglycemic agents), non-adherence to treatment (-12.3 in the DE score for persons forgetting their weekly treatment), increasing weight (-8.5 & -9.7 in the PD & DE scores respectively, as compared to stable weight), at least one psychiatrist visit in 2001 (-8.9 in the DE score), and universal medical insurance coverage (-7.9 in the PD score) (due to low income).</p> <p>Conclusion</p> <p>Prevention and management of microvascular complications or adherence to treatment (modifiable factors) could be essential to preserving or improving PBF among people with type 2 diabetes. A specific approach to type 2 diabetes management may be required in groups with a low socioeconomic profile (particularly people with universal medical insurance coverage), or other non modifiable factors.</p

Prostate cancer outcomes in France: treatments, adverse effects and two-year mortality

BACKGROUND: This very large population-based study investigated outcomes after a diagnosis of prostate cancer (PCa) in terms of mortality rates, treatments and adverse effects. METHODS: Among the 11 million men aged 40 years and over covered by the general national health insurance scheme, those with newly managed PCa in 2009 were followed for two years based on data from the national health insurance information system (SNIIRAM). Patients were identified using hospitalisation diagnoses and specific refunds related to PCa and PCa treatments. Adverse effects of PCa treatments were identified by using hospital diagnoses, specific procedures and drug refunds. RESULTS: The age-standardised two-year all-cause mortality rate among the 43,460 men included in the study was 8.4%, twice that of all men aged 40 years and over. Among the 36,734 two-year survivors, 38% had undergone prostatectomy, 36% had been treated by hormone therapy, 29% by radiotherapy, 3% by brachytherapy and 20% were not treated. The frequency of treatment-related adverse effects varied according to age and type of treatment. Among men between 50 and 69 years of age treated by prostatectomy alone, 61% were treated for erectile dysfunction and 24% were treated for urinary disorders. The frequency of treatment for these disorders decreased during the second year compared to the first year (erectile dysfunction: 41% vs 53%, urinary disorders: 9% vs 20%). The frequencies of these treatments among men treated by external beam radiotherapy alone were 7% and 14%, respectively. Among men between 50 and 69 years with treated PCa, 46% received treatments for erectile dysfunction and 22% for urinary disorders. For controls without PCa but treated surgically for benign prostatic hyperplasia, these frequencies were 1.5% and 6.0%, respectively. CONCLUSIONS: We report high survival rates two years after a diagnosis of PCa, but a high frequency of PCa treatment-related adverse effects. These frequencies remain underestimated, as they are based on treatments for erectile dysfunction and urinary disorders and do not reflect all functional outcomes. These results should help urologists and general practitioners to inform their patients about outcomes at the time of screening and diagnosis, and especially about potential treatment-related adverse effects

Mortality from circulatory diseases by specific country of birth across six European countries: test of concept

Background: Important differences in cardiovascular disease (CVD) mortality by country of birth have been shown within European countries. We now focus on CVD mortality by specific country of birth across European countries. Methods: For Denmark, England and Wales, France, The Netherlands, Scotland and Sweden mortality information on circulatory disease, and the subcategories of ischaemic heart disease, and cerebrovascular disease, was analysed by country of birth. Information on population was obtained from census data or population registers. Directly age-standardized rates per 100 000 were estimated by sex for each country of birth group using the WHO World Standard population 2000-25 structure. For differences in the results, at least one of the two 95% confidence intervals did not overlap. Results: Circulatory mortality was similar across countries for men born in India (355.7 in England and Wales, 372.8 in Scotland and 244.5 in Sweden). For other country of birth groups-China, Pakistan, Poland, Turkey and Yugoslavia-there were substantial between-country differences. For example, men born in Poland had a rate of 630.0 in Denmark and 499.3 in England and Wales and 153.5 in France; and men born in Turkey had a rate of 439.4 in Denmark and 231.4 in The Netherlands. A similar pattern was seen in women, e.g. Poland born women had a rate of 264.9 in Denmark, 126.4 in England and Wales and 54.4 in France. The patterns were similar for ischaemic heart disease mortality and cerebrovascular disease mortality. Conclusion: Cross-country comparisons are feasible and the resulting findings are interesting. They merit public health consideratio

Instauration d'une insulinothérapie dans le diabète de type 2 (données épidémiologiques, étude entred 2001-2003)

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Surveillance épidémiologique du diabète de l'enfant

Institut de veille sanitaire — Surveillance épidémiologique du diabète de l’enfant / p. 3Le diabète de l’enfant constitue une pathologie chronique auxrépercussions lourdes sur la qualité de vie de l’enfant et de sa familleet sur sa santé actuelle et future. La prévalence a été estimée en 1998,par l’Assurance maladie, à 0,95 pour mille, soit environ 15 000 enfantsâgés de moins de 20 ans, et l’incidence à 9,5 cas pour 100 000, soitenviron 1 400 nouveaux cas par an dans le registre fermé en 1997.Le diabète de type 1 est en augmentation chez le jeune enfant (3 %par an), alors que le diabète de type 2 apparaît chez l’adolescent,conséquence de l’épidémie d’obésité. Or le diabète de type 2, considérécomme le diabète de l’adulte d’âge mûr, est apparu chez l’enfantaméricain il y a 10 ans, et y est maintenant aussi fréquent que letype 1. En France, l’évolution et les caractéristiques du diabète detype 1, ainsi que l’apparition du diabète de type 2 chez l’enfant, sontmal connues.L’Institut de veille sanitaire (InVS) est chargé de la surveillance del’état de santé de la population vivant en France, ce qui inclut lasurveillance des maladies chroniques, donc celle du diabète. Unprogramme de surveillance du diabète a été établi en 2002, et sestravaux ont principalement concerné l’adulte diabétique.Au regard des compétences et de l’expérience de l’Institut nationalde la santé et de la recherche médicale (Inserm) dans ce domaine,le Département des maladies chroniques et traumatismes de l’InVSa confié à l’unité 690 de l’Inserm, intitulée "Diabète de l’enfant etdéveloppement", un contrat de prestation portant sur la "surveillanceépidémiologique du diabète chez l’enfant". Et ceci, afin de disposerd’un avis d’experts sur l’état des connaissances épidémiologiques,les outils disponibles et les besoins spécifiques à la France dans laperspective de développer un système de surveillance pertinent. Lesobjectifs spécifiques de ce contrat étaient :d’établir le bilan des connaissances actuelles et des outils utilesen épidémiologie du diabète de l’enfant à partir des donnéesdisponibles en Europe et en Amérique du Nord ;d’établir les besoins en connaissance épidémiologique sur le diabètede l’enfant en France ;de proposer les orientations pratiques d’un programme desurveillance pour l’InVS dans les années à venir

Less amputations for diabetic foot ulcer from 2008 to 2014, hospital management improved but substantial progress is still possible: A French nationwide study.

ObjectiveTo assess the improvement in the management of diabetes and its complications based on the evolution of hospitalisation rates for diabetic foot ulcer (DFU) and lower extremity amputation (LEA) in individuals with diabetes in France.MethodsData were provided by the French national health insurance general scheme from 2008 to 2014. Hospitalisations for DFU and LEA were extracted from the SNIIRAM/SNDS French medical and administrative database.ResultsIn 2014, 22,347 hospitalisations for DFU and 8,342 hospitalisations for LEA in patients with diabetes were recorded. Between 2008 and 2014, the standardised rate of hospitalisation for DFU raised from 508 to 701/100,000 patients with diabetes. In the same period, the standardised rate of LEA decreased from 301 to 262/100,000 patients with diabetes. The level of amputation tended to become more distal. The proportion of men (69% versus 73%) and the frequency of revascularization procedures (39% versus 46%) increased. In 2013, the one-year mortality rate was 23% after hospitalisation for DFU and 26% after hospitalisation for LEA.ConclusionsFor the first time in France, the incidence of a serious complication of diabetes, i.e. amputations, has decreased in relation with a marked improvement in hospital management