Defining Potentially Inappropriate Prescriptions for Hypoglycaemic Agents to Improve Computerised Decision Support: A Study Protocol.

International audienceIn France, around 5% of the general population are taking drug treatments for diabetes mellitus (mainly type 2 diabetes mellitus, T2DM). Although the management of T2DM has become more complex, most of these patients are managed by their general practitioner and not a diabetologist for their antidiabetics treatments; this increases the risk of potentially inappropriate prescriptions (PIPs) of hypoglycaemic agents (HAs). Inappropriate prescribing can be assessed by approaches that are implicit (expert judgement based) or explicit (criterion based). In a mixed, multistep process, we first systematically reviewed the published definitions of PIPs for HAs in patients with T2DM. The results will be used to create the first list of explicit definitions. Next, we will complete the definitions identified in the systematic review by conducting a qualitative study with two focus groups of experts in the prescription of HAs. Lastly, a Delphi survey will then be used to build consensus among participants; the results will be validated in consensus meetings. We developed a method for determining explicit definitions of PIPs for HAs in patients with T2DM. The resulting explicit definitions could be easily integrated into computerised decision support tools for the automated detection of PIPs

Impact of 4-month training on glycaemic excursions in daily life in adults living with type 1 diabetes

International audienc

La monotraite quotidienne appliquée en brebis laitières de race Lacaune : synthèse de cinq années de recherche

National audienceSeveral experiments were conducted for evaluating the effects of once daily milking (ODM) in Lacaune dairy ewes throughout the milking period. Milk production and composition, udder health, daily feed intake and energy metabolism were individually monitored. The effects of adopting ODM at the farm and the production region levels were also modelled. Individual milk yield was 14% lower either in adult or primiparous ewes. Milk fat and protein contents were lower and higher, respectively, when ewes were fed ad libitum; however, these parameters were almost not modified when diets were adjusted to the actual milk yield. Dry matter intake was not affected by ODM, which led to a marked positive energy balance in ODM ewes. The last was well illustrated by the metabolic profile of the ewes, showing lower body reserves mobilization in ODM ewes. The udder morphology and functioning was only disturbed during the first week of ODM, but it was rapidly recovered without associated further health constraints. At the farm level, adopting the ODM regime showed a decrease in the global farm incomes, possibly to be recovered by starting ODM in the mid-lactation or prolonging the milking period length. Further researches will be required for characterizing in a deeper way the related effects of applying ODM under different feeding and management situations at the flock, farm and regional production scales.Une série d’expérimentations a été conduite pour mesurer l’impact de la monotraite à l’échelle de la lactation de brebis laitières de race Lacaune. La production de lait et sa composition, la physiologie et la morphologie de la mamelle, l’ingestion et le métabolisme énergétique ont été mesurés tout au long de la période de traite, du sevrage au tarissement. L’impact de la monotraite a été modélisé à l’échelle de l’exploitation et du bassin de production. La perte de lait a été de 14% chez les multipares comme les primipares. Selon la ration offerte, le taux butyreux a diminué ou a eu tendance à augmenter, alors que le taux protéique n’a pas été modifié ou a augmenté en lien avec une augmentation des protéines solubles. Les quantités ingérées n’étaient pas différentes entre brebis en traite biquotidienne et monotraite, ce qui a entraîné un bilan énergétique positif supérieur pour ces dernières. Cela s’est traduit par des taux d’acides gras non estérifiés rapidement plus bas et de leptine supérieurs. La mamelle a été perturbée dans les premiers jours de monotraite, mais a rapidement retrouvé son intégrité du fait d’une bonne plasticité sans aucune conséquence sur sa santé. Au niveau de l’exploitation, la monotraite entraîne une perte de revenu qui peut être compensée en tout ou partie par un passage en monotraite à un stade plus tardif ou un allongement de la période de traite. Des travaux complémentaires conduits à l’échelle de l’exploitation permettraient de mieux préciser les répercussions de cette pratique à ce niveau et à celui du bassin de production