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

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

Direct Medical Costs of Type 2 Diabetes in France: An Insurance Claims Database Analysis

International audienceObjectives: Our objects was to estimate the direct healthcare costs of type 2 diabetes mellitus (T2DM) in France in 2013.Methods: Data were drawn from a random sample of ≈600,000 patients registered in the French national health insurances database, which covers 90% of the French population. An algorithm was used to select patients with T2DM. Direct healthcare costs from a collective perspective were derived from the database and compared with those from a control group to estimate the cost of diabetes and related comorbidities. Overall direct costs were also compared according to the diabetes therapies used throughout the year 2013.Results: Cost analysis was available for a sample of 25,987 patients with T2DM (mean age 67.5 ± standard deviation 12.5; 53.9% male) matched with a control group of 76,406 individuals without diabetes. Overall per patient per year medical expenditures were €6506 ± 10,106 in the T2DM group as compared with €3668 ± 6954 in the control group. The cost difference between the two groups was €2838 per patient per year, mainly due to hospitalizations, medication and nursing care costs. Total per capita annual costs were lowest for patients receiving metformin monotherapy (€4153 ± 6170) and highest for those receiving insulin (€12,890). However, apart from patients receiving insulin, costs did not differ markedly across the different oral treatment patterns.Conclusion: Extrapolating these results to the whole T2DM population in France, total direct costs of diagnosed T2DM in 2013 was estimated at over €8.5 billion. This estimate highlights the substantial economic burden of this condition on society