Trends in childhood type 1 diabetes incidence in France, 2010 - 2015

AIMS: To estimate type 1 diabetes incidence in children in France and its evolution between 2010 and 2015, based on comprehensive medico-administrative databases. METHODS: The algorithm built to identify new cases of type 1 diabetes selected children aged between 6 months and 14 years who had at least one hospital stay for diabetes, followed by their first insulin treatment, excluding children suffering from another form of diabetes. Age and sex specific annual incidence rates were estimated and time trend was analyzed using Poisson regression. RESULTS: A total of 12 067 children were identified as newly diagnosed with type 1 diabetes and the annual incidence rates increased between 2010 and 2015 (from 15.4 [95% Confidence Interval: 14.7;16.1] to 19.1 [18.3;19.9] per 100 000 person-years), among boys and girls, and in each age group (4 and under, 5 - 9, 10 - 14 year olds). The annual rate of increase was 4.0% [3.4;4.6]. This trend was not significantly different between each gender, and each age group. CONCLUSIONS: Valid database information on disease incidence is essential for healthcare planning and provides a valuable resource for health research. An increase of the incidence rate of type 1 diabetes in children was highlighted in both sexes and in all age groups

Prevalence and determinants of Transient Congenital Hypothyroidism in children with Eutopic Gland in France: a retrospective cohort study

International audienceCONTEXT: The increase in the incidence of congenital hypothyroidism (CH) reported worldwide may in part be explained by an increase in the transient form of CH. OBJECTIVES: We aimed to estimate the proportion of transient CH (TCH) in France, and to identify associated neonatal and young child characteristics. PATIENTS AND METHODS: We used probabilistic record linkage to link children with eutopic gland born between 2006 and 2012 recorded in the national French CH registry and the French national health data system (SNDS). Of the 703 children recorded, 484 (68.8%) were linked. We retrospectively examined reimbursement for oral levothyroxine (LT4) between 01/01/2006 and 31/12/2017. Children who had discontinued treatment for six months or more before 31/12/2017 were classified as having TCH. We used a Cox model to examine the factors associated with TCH. RESULTS: Among the main study sample (n=471), 53.5% were female, 14.2% were preterm, and 13.8% had low birth weight. One-quarter (n=111, 24.3%) had mild CH (thyroid-stimulating hormone (TSH)\textless50mU/L (serum) at diagnosis and a median LT4 dose at treatment initiation of 30 μg/day. One third (n=155, 32.9%) had TCH. Premature birth (adjusted Hazard Ratio=2.1 [1.0-4.2]), a TSH\textless50 mU/L at CH screening (7.4 [3.2-17.1]), LT4 dose received at 12 months of age (0.98 [0.97-0.99, p=0.003]), congenital cardiac malformations (6.6 [1.5-29.0]), and year of birth (1.2 [1.1-1.4]) were all associated with TCH. CONCLUSIONS: One third of the children had TCH and it was associated with several characteristics at birth and post-partum. These data are useful for CH medical management and epidemiological surveillance

Algorithms based on medico-administrative data in the field of endocrine, nutritional and metabolic diseases, especially diabetes

National audienceBackground. - Medico-administrative databases represent a very interesting source of information in the field of endocrine, nutritional and metabolic diseases. The objective of this article is to describe the early works of the Redsiam working group in this field. Methods. - Algorithms developed in France in the field of diabetes, the treatment of dyslipidemia, precocious puberty, and bariatric surgery based on the National Inter-schema Information System on Health Insurance (SNIIRAM) data were identified and described. Results. - Three algorithms for identifying people with diabetes are available in France. These algorithms are based either on full insurance coverage for diabetes or on claims of diabetes treatments, or on the combination of these two methods associated with hospitalizations related to diabetes. Each of these algorithms has a different purpose, and the choice should depend on the goal of the study. Algorithms for identifying people treated for dyslipidemia or precocious puberty or who underwent bariatric surgery are also available. Conclusion. - Early work from the Redsiam working group in the field of endocrine, nutritional and metabolic diseases produced an inventory of existing algorithms in France, linked with their goals, together with a presentation of their limitations and advantages, providing useful information for the scientific community. This work will continue with discussions about algorithms on the incidence of diabetes in children, thyroidectomy for thyroid nodules, hypothyroidism, hypoparathyroidism, and amyloidosis

Déterminants de la mortalité des personnes diabétiques de type 2. Cohortes Entred, France, 2002-2013

International audienceIntroduction: Mortality of people with diabetes is still high in France, as is their excess mortality compared with the general population. In this context, it is essential to understand the determinants of mortality in people with diabetes. The objective of this study was to examine the determinants of mortality in people with type 2 diabetes.Methods: The study population consisted in people with type 2 diabetes that replied to a self-administered questionnaire from the ENTRED 2001 and the ENTRED 2007 surveys. Participants were followed up until February 2013. Survival analyses were performed with a Cox model using age as a time scale. A subgroup analysis was conducted among participants for whom physicians had replied to a questionnaire.Results: Among the 7,218 participants, median age at inclusion and death were 65 and 72 years, respectively. The proportion of deaths was 21%.In multivariate analysis, determinants of mortality were: non-morbid obesity (RR=1.21, 95%CI: [1.02-1.43]) and morbid obesity (RR=1.76 [1.43-2.18]), diagnosis of diabetes established after symptoms (RR=1.19 [1.03-1.37]) rather than after a screening and tobacco consumption (RR=1.49 [1.26-1.77]), along with the fact of being a man (RR=1.76 [1.53-2.02]), participation in the 2007 ENTRED cohort vs. 2001 ENTRED cohort (RR=0.84 [0.74-0.95]), socio-economic category (with an excess risk in blue-collar workers (RR=1.36 [1.11-1.67]) compared to executives), registration for long term illness exemption (RR=1.29 [1.08-1.54]), treatment by insulin alone (RR=1.45 [1.21-1.74]) or by insulin and one or more oral antidiabetic drugs (RR=1.37 [1.12-1.68]) compared to a treatment based on one oral antidiabetic drug only, foot or renal complications (RR=1.97 [1.68-2.31]) and coronary complications (RR=1.39 [1.22-1.59]).Conclusion: Some determinants identified are widely modifiable. These results highlight the importance of prevention, which must involve appropriate therapeutic education in order to change lifestyles of people with type 2 diabetes, and improve the management of complications. This prevention must be adapted to the socio-economic profile of people with diabetes to reduce social inequalities observed in mortality linked with diabetes.Introduction : La mortalité des personnes diabétiques reste élevée en France, de même que leur surmortalité par rapport à la population générale. Dans ce contexte, la compréhension des déterminants de la mortalité des personnes diabétiques, peu étudiés en France, est essentielle. L’objectif de notre étude était d’étudier les déterminants de la mortalité des personnes diabétiques de type 2.Méthodes : La population d’étude était composée des personnes diabétiques de type 2 ayant répondu à un auto-questionnaire dans le cadre des enquêtes Entred 2001 ou Entred 2007. Les participants ont été suivis jusqu’en février 2013. Les analyses de survie ont été réalisées à partir d’un modèle de Cox utilisant l’âge comme échelle de temps. Une analyse de sous-groupe a été réalisée sur les personnes dont le médecin avait répondu à un questionnaire.Résultats : Parmi les 7 218 personnes incluses, les âges moyens à l’inclusion et au décès étaient respectivement de 65 et 72 ans. La proportion de décès était de 21%.En analyse multivariée, les déterminants de la mortalité étaient : l’obésité non morbide (RR=1,21, IC95%: [1,02-1,43]) et l’obésité morbide (RR=1,76 [1,43-2,18]), le diagnostic de diabète posé suite à des symptômes (RR=1,19 [1,03-1,37]) plutôt que suite à un dépistage et la consommation de tabac (RR=1,49 [1,26-1,77]), ainsi que le sexe masculin (RR=1,76 [1,53-2,02]), l’appartenance à la cohorte Entred 2007 par rapport à Entred 2001 (RR=0,84 [0,74-0,95]), le niveau socioéconomique (avec un sur-risque notamment chez les ouvriers (RR=1,36 [1,11-1,67]) par rapport aux cadres), le fait de bénéficier d’une affection longue durée (RR=1,29 [1,08-1,54]), le traitement par insuline seule (RR=1,45 [1,21-1,74]) ou par insuline associée à un ou des antidiabétiques oraux (RR=1,37 [1,12-1,68]) par rapport à un traitement par un seul antidiabétique oral et les complications podologiques ou rénales graves (RR=1,97 [1,68-2,31]) et coronaires (RR=1,39 [1,22-1,59]).Conclusion : Certains déterminants mis en évidence sont largement modifiables. Ces résultats rappellent l’importance de la prévention, qui doit passer par une éducation thérapeutique adaptée, afin de modifier le mode de vie des personnes diabétiques de type 2 et d’améliorer la prise en charge des complications. Cette prévention doit être adaptée au profil socioéconomique de la personne diabétique afin de réduire les inégalités sociales observées dans la mortalité liée au diabète

Is the type 2 diabetes epidemic plateauing in France? A nationwide population-based study

International audienceAim. - Nationwide data on the evolution of diabetes incidence and prevalence are scarce in France. For this reason, our objectives were to determine type 2 diabetes prevalence and incidence rates between 2010 and 2017, stratified by gender, age and region, and to assess annual time trends over the study period in adults aged >= 45 years.Methods. - Diabetes cases in the National Health Data System (SNDS), which covers the entire French population (66 million people), were identified through a validated algorithm. Gender- and age-specific prevalence and incidence rates were estimated. Negative binomial models, adjusted for gender, age and region, were used to assess annual time trends for prevalence and incidence throughout the study period.Results. - During 2017,3,144,225 diabetes cases aged >= 45 years were identified. Over the study period, prevalence increased slightly (men from 11.5% to 12.1%, women from 7.9% to 8.4%) whereas incidence decreased (men from 11 to 9.7, women from 7.2 to 6.2 per 1000 person-years). In only four groups did prevalence rates decrease: men aged 45-65 years; women aged 45-60 years; women in Reunion; and women in Martinique. An increasing annual time trend was observed for prevalence (men: +0.9% [95% CI: +0.7%, +1%]; women: +0.4% [95% CI: +0.2%, +0.6%]) with a decreasing annual time trend for incidence in both genders (men: -2.6% [95% CI: -3.1%, -2.0%]; women: -3.9% [95% CI: -4.5%, -3.4%]).Conclusion. - Further efforts towards diabetes prevention are required to ensure that incidence rates in France continue to diminish, as the disorder continues to represent an important public-health burden. (C) 2020 Published by Elsevier Masson SAS

Identifying diabetes cases in health administrative databases: a validation study based on a large French cohort

International audienceObjectivesIn the French national health insurance information system (SNDS) three diabetes case definition algorithms are applied to identify diabetic patients. The objective of this study was to validate those using data from a large cohort.MethodsThe CONSTANCES cohort (Cohorte des consultants des Centres d'examens de sante) comprises a randomly selected sample of adults living in France. Between 2012 and 2014, data from 45,739 participants recorded in a self-administrated questionnaire and in a medical examination were linked to the SNDS. Two gold standards were defined: known diabetes and pharmacologically treated diabetes. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and kappa coefficients (k) were estimated.ResultsAll three algorithms had specificities and NPV over 99%. Their sensitivities ranged from 73 to 77% in algorithm A, to 86 and 97% in algorithm B and to 93 and 99% in algorithm C, when identifying known and pharmacologically treated diabetes, respectively. Algorithm C had the highest k when using known diabetes as the gold standard (0.95). Algorithm B had the highest k (0.98) when testing for pharmacologically treated diabetes.ConclusionsThe SNDS is an excellent source for diabetes surveillance and studies on diabetes since the case definition algorithms applied have very good test performances

Déterminants de la mortalité des personnes diabétiques de type 2. Cohortes Entred, France, 2002-2013

International audienceIntroduction: Mortality of people with diabetes is still high in France, as is their excess mortality compared with the general population. In this context, it is essential to understand the determinants of mortality in people with diabetes. The objective of this study was to examine the determinants of mortality in people with type 2 diabetes.Methods: The study population consisted in people with type 2 diabetes that replied to a self-administered questionnaire from the ENTRED 2001 and the ENTRED 2007 surveys. Participants were followed up until February 2013. Survival analyses were performed with a Cox model using age as a time scale. A subgroup analysis was conducted among participants for whom physicians had replied to a questionnaire.Results: Among the 7,218 participants, median age at inclusion and death were 65 and 72 years, respectively. The proportion of deaths was 21%.In multivariate analysis, determinants of mortality were: non-morbid obesity (RR=1.21, 95%CI: [1.02-1.43]) and morbid obesity (RR=1.76 [1.43-2.18]), diagnosis of diabetes established after symptoms (RR=1.19 [1.03-1.37]) rather than after a screening and tobacco consumption (RR=1.49 [1.26-1.77]), along with the fact of being a man (RR=1.76 [1.53-2.02]), participation in the 2007 ENTRED cohort vs. 2001 ENTRED cohort (RR=0.84 [0.74-0.95]), socio-economic category (with an excess risk in blue-collar workers (RR=1.36 [1.11-1.67]) compared to executives), registration for long term illness exemption (RR=1.29 [1.08-1.54]), treatment by insulin alone (RR=1.45 [1.21-1.74]) or by insulin and one or more oral antidiabetic drugs (RR=1.37 [1.12-1.68]) compared to a treatment based on one oral antidiabetic drug only, foot or renal complications (RR=1.97 [1.68-2.31]) and coronary complications (RR=1.39 [1.22-1.59]).Conclusion: Some determinants identified are widely modifiable. These results highlight the importance of prevention, which must involve appropriate therapeutic education in order to change lifestyles of people with type 2 diabetes, and improve the management of complications. This prevention must be adapted to the socio-economic profile of people with diabetes to reduce social inequalities observed in mortality linked with diabetes.Introduction : La mortalité des personnes diabétiques reste élevée en France, de même que leur surmortalité par rapport à la population générale. Dans ce contexte, la compréhension des déterminants de la mortalité des personnes diabétiques, peu étudiés en France, est essentielle. L’objectif de notre étude était d’étudier les déterminants de la mortalité des personnes diabétiques de type 2.Méthodes : La population d’étude était composée des personnes diabétiques de type 2 ayant répondu à un auto-questionnaire dans le cadre des enquêtes Entred 2001 ou Entred 2007. Les participants ont été suivis jusqu’en février 2013. Les analyses de survie ont été réalisées à partir d’un modèle de Cox utilisant l’âge comme échelle de temps. Une analyse de sous-groupe a été réalisée sur les personnes dont le médecin avait répondu à un questionnaire.Résultats : Parmi les 7 218 personnes incluses, les âges moyens à l’inclusion et au décès étaient respectivement de 65 et 72 ans. La proportion de décès était de 21%.En analyse multivariée, les déterminants de la mortalité étaient : l’obésité non morbide (RR=1,21, IC95%: [1,02-1,43]) et l’obésité morbide (RR=1,76 [1,43-2,18]), le diagnostic de diabète posé suite à des symptômes (RR=1,19 [1,03-1,37]) plutôt que suite à un dépistage et la consommation de tabac (RR=1,49 [1,26-1,77]), ainsi que le sexe masculin (RR=1,76 [1,53-2,02]), l’appartenance à la cohorte Entred 2007 par rapport à Entred 2001 (RR=0,84 [0,74-0,95]), le niveau socioéconomique (avec un sur-risque notamment chez les ouvriers (RR=1,36 [1,11-1,67]) par rapport aux cadres), le fait de bénéficier d’une affection longue durée (RR=1,29 [1,08-1,54]), le traitement par insuline seule (RR=1,45 [1,21-1,74]) ou par insuline associée à un ou des antidiabétiques oraux (RR=1,37 [1,12-1,68]) par rapport à un traitement par un seul antidiabétique oral et les complications podologiques ou rénales graves (RR=1,97 [1,68-2,31]) et coronaires (RR=1,39 [1,22-1,59]).Conclusion : Certains déterminants mis en évidence sont largement modifiables. Ces résultats rappellent l’importance de la prévention, qui doit passer par une éducation thérapeutique adaptée, afin de modifier le mode de vie des personnes diabétiques de type 2 et d’améliorer la prise en charge des complications. Cette prévention doit être adaptée au profil socioéconomique de la personne diabétique afin de réduire les inégalités sociales observées dans la mortalité liée au diabète