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Campas-Lebecque MN, Pochelu S, Vautier V, Bacheré N, Beau C, Benoit M, Cammas B, Carré M, Chevrel J, Compain F, Fargeot-Espaliat A, Franc M, Galtier A, Gambert C, Lacoste A, Lienhardt A, Martineau L, Oilleau L, Percot-Blondy M, Tamboura A, Valade A, Barat P. Do children and adolescents with type 1 diabetes suffer from a lack of resources in France? Results from a benchmark study in the New Aquitaine region. Arch Pediatr 2021; 28:301-306. [PMID: 33744119 DOI: 10.1016/j.arcped.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/09/2020] [Accepted: 02/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND A benchmark study was conducted in the southwest of France, in the New Aquitaine region, to investigate metabolic outcomes and availability of resources in pediatric diabetes units. We assessed whether the level of care was in accordance with the International Society for Pediatric and Adolescent Diabetes recommendations. METHODS Demographic and clinical data were collected, as were all HbA1c tests for the 2017 calendar year. Pediatricians specialized in diabetes care were invited to complete an online survey concerning means allocated to the management of type 1 diabetes in their centers. RESULTS Sixteen centers provided data for 1277 patients and 3873 clinical visits. A total of 1115 children suffering from diabetes for more than 1 year were studied. Median HbA1c was 8% (7.4-8.6) for the whole region. Only 29.2% of children had good metabolic control in accordance with the <7.5% target. We identified slight but significant variation in glycemic control among centers (P=0.029). The use of an insulin pump varied greatly among centers but did not explain HbA1c differences. We did not identify a correlation between medical or paramedical time dedicated to the follow-up of diabetic patients and the mean HbA1c of each center. For 100 diabetic patients, follow-up was provided by 0.42 physicians (0.23-1.50), 0.15 nurses (0-0.56), 0.12 dietitians (0-0.48), and 0.07 psychologists (0-0.30). CONCLUSION This study demonstrates a lack of human resources allocated to the management of type 1 diabetes in the region that is far below international recommendations. The proportion of children achieving the international glycemic target is low. There is a clear need to improve glycemic control in children, which will only be possible with improved professional practices, encouraged by benchmark studies, and by increasing the size of our multidisciplinary teams.
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Affiliation(s)
- M-N Campas-Lebecque
- Unité d'endocrinologie et diabétologie pédiatrique, CHU de Bordeaux, place Amélie Rabat Léon, 33076 Bordeaux, France.
| | - S Pochelu
- Unité d'endocrinologie et diabétologie pédiatrique, CHU de Bordeaux, place Amélie Rabat Léon, 33076 Bordeaux, France
| | - V Vautier
- Unité d'endocrinologie et diabétologie pédiatrique, CHU de Bordeaux, place Amélie Rabat Léon, 33076 Bordeaux, France
| | - N Bacheré
- Unité de pédiatrie, CH Layné, 40024 Mont De Marsan, France
| | - C Beau
- Unité de pédiatrie, CH Libourne, 112, rue de la Marne, 33505 Libourne, France
| | - M Benoit
- Unité de pédiatrie, CH de Saintonge, 11, boulevard Ambroise-Paré, 17108 Saintes, France
| | - B Cammas
- 22, rue Guillemin, 33300 Bordeaux, France
| | - M Carré
- Unité de pédiatrie, CH Côte-Basque, 13, avenue Jacques-Loeb, BP, 64109 Bayonne, France
| | - J Chevrel
- Unité de pédiatrie, CH Côte-d'argent, boulevard Yves-Du-Manoir, 40107 Dax, France
| | - F Compain
- Unité de pédiatrie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - A Fargeot-Espaliat
- Unité de pédiatrie, CH de Brive, 1, boulevard du Dr-Verlhac, 19312 Brive La Gaillarde, France
| | - M Franc
- Unité de pédiatrie, CH Agen-Nérac, 47923 Agen, France
| | - A Galtier
- Unité de pédiatrie, CH Samuel Pozzi, 9, boulevard Pr-Calmette, 24100 Bergerac, France
| | - C Gambert
- Unité de pédiatrie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - A Lacoste
- Polyclinique Bordeaux Rive Droite, 24, rue des Cavailles, 33310 Lormont, France
| | - A Lienhardt
- Unité d'endocrinologie et diabétologie pédiatrique, CHU Dupuytren, 8, avenue Larrey, 87042 Limoges, France
| | - L Martineau
- Unité de pédiatrie, CH d'Angoulême, rond point de Girac, 16959 Angoulême, France
| | - L Oilleau
- Unité de pédiatrie, CH de Pau, 4, boulevard Hauterive, 64046 Pau, France
| | - M Percot-Blondy
- Unité de pédiatrie, CH de Périgueux, 80, avenue Pompidou, 24019 Périgueux, France
| | - A Tamboura
- Unité de pédiatrie, CH de Rochefort, 1, avenue de Béligon, 17301 Rochefort, France
| | - A Valade
- Unité de pédiatrie, CH Côte-Basque, 13, avenue Jacques-Loeb, BP, 64109 Bayonne, France
| | - P Barat
- Unité d'endocrinologie et diabétologie pédiatrique, CHU de Bordeaux, place Amélie Rabat Léon, 33076 Bordeaux, France
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Balazard F, Le Fur S, Valtat S, Valleron AJ, Bougnères P, Thevenieau D, Chatel CF, Desailloud R, Bony-Trifunovic H, Ducluzeau PH, Coutant R, Caudrelier S, Pambou A, Dubosclard E, Joubert F, Jan P, Marcoux E, Bertrand AM, Mignot B, Penformis A, Stuckens C, Piquemal R, Barat P, Rigalleau V, Stheneur C, Fournier S, Kerlan V, Metz C, Fargeot-Espaliat A, Reznic Y, Olivier F, Gueorguieva I, Monier A, Radet C, Gajdos V, Terral D, Vervel C, Bendifallah D, Signor CB, Dervaux D, Benmahammed A, Loeuille GA, Popelard F, Guillou A, Benhamou PY, Khoury J, Brossier JP, Bassil J, Clavel S, Le Luyer B, Bougnères P, Labay F, Guemas I, Weill J, Cappoen JP, Nadalon S, Lienhardt-Roussie A, Paoli A, Kerouedan C, Yollin E, Nicolino M, Simonin G, Cohen J, Atlan C, Tamboura A, Dubourg H, Pignol ML, Talon P, Jellimann S, Chaillous L, Baron S, Bortoluzzi MN, Baechler E, Salet R, Zelinsky-Gurung A, Dallavale F, Larger E, Laloi-Michelin M, Gautier JF, Guérin B, Oilleau L, Pantalone L, Lukas C, Guilhem I, De Kerdanet M, Wielickzo MC, Priou-Guesdon M, Richard O, Kurtz F, Laisney N, Ancelle D, Parlier G, Boniface C, Bockel DP, Dufillot D, Razafimahefa B, Gourdy P, Lecomte P, Pepin-Donat M, Combes-Moukhovsky ME, Zymmermann B, Raoulx M, Dumont AGEC. Association of environmental markers with childhood type 1 diabetes mellitus revealed by a long questionnaire on early life exposures and lifestyle in a case-control study. BMC Public Health 2016; 16:1021. [PMID: 27682602 PMCID: PMC5041527 DOI: 10.1186/s12889-016-3690-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/20/2016] [Indexed: 12/22/2022] Open
Abstract
Background The incidence of childhood type 1 diabetes (T1D) incidence is rising in many countries, supposedly because of changing environmental factors, which are yet largely unknown. The purpose of the study was to unravel environmental markers associated with T1D. Methods Cases were children with T1D from the French Isis-Diab cohort. Controls were schoolmates or friends of the patients. Parents were asked to fill a 845-item questionnaire investigating the child’s environment before diagnosis. The analysis took into account the matching between cases and controls. A second analysis used propensity score methods. Results We found a negative association of several lifestyle variables, gastroenteritis episodes, dental hygiene, hazelnut cocoa spread consumption, wasp and bee stings with T1D, consumption of vegetables from a farm and death of a pet by old age. Conclusions The found statistical association of new environmental markers with T1D calls for replication in other cohorts and investigation of new environmental areas. Trial registration Clinical-Trial.gov NCT02212522. Registered August 6, 2014. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3690-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F Balazard
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, Paris, France. .,INSERM U1169, Hôpital Bicêtre, Université Paris-Sud, Kremlin-Bicêtre, France.
| | - S Le Fur
- INSERM U1169, Hôpital Bicêtre, Université Paris-Sud, Kremlin-Bicêtre, France.,Department of pediatric endocrinology, Hôpital Bicêtre, Kremlin-Bicêtre, France
| | - S Valtat
- INSERM U1169, Hôpital Bicêtre, Université Paris-Sud, Kremlin-Bicêtre, France
| | - A J Valleron
- INSERM U1169, Hôpital Bicêtre, Université Paris-Sud, Kremlin-Bicêtre, France
| | - P Bougnères
- INSERM U1169, Hôpital Bicêtre, Université Paris-Sud, Kremlin-Bicêtre, France.,Department of pediatric endocrinology, Hôpital Bicêtre, Kremlin-Bicêtre, France
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