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Master Thesis

Évaluation des pratiques professionnelles de dépistage et de prise en charge du diabète chez les enfants atteints de mucoviscidose à Bordeaux

Abstract : Improvement in managing patients with cystic fibrosis has induced an increase of their life expectancy. At the same time, secondary effects have appeared, primarily carbohydrate metabolism disorders for which Oral Glucose Tolerance Test (OGTT) is the reference screening test. A protocol for screening and managing diabetes in patients with cystic fibrosis was established by the French Society of Cystic Fibrosis in 2010. Aims of the study: To evaluate the professional practices of screening and management of carbohydrate metabolism disorders in patients followed by the Resources and Competence Centre of Cystic Fibrosis at the Children’s Hospital of Bordeaux between 1 January 2010 and 31 December 2013. The secondary objectives were to describe the management of patients further to the diagnosis of glucose anomaly and to highlight the new practices of help to the diagnosis. Materials and methods: Patients considered were born in or after 1995. The framework recommends an OGTT per year for patients over 10 or in the case of unexplained general impairment. Then, patient care is managed in function of the carbohydrate metabolic state: glucose intolerance (GI), or diabetes with hyperglycaemia (HD+) or without (HD-) hyperglycaemia. Results: Over a total population of 165 children, the proportion of OGTTs carried out was 28.7%. With the patients over 10, OGTT was performed for 68.2% of the expected OGTTs. Carbohydrate metabolic disorders were found for 37.7% of the OGTTs, of which 28.3% of GI, 8.8% of HD- and 0.6% of HD+. For patients under 10, the number of OGTTs performed due to general impairment corresponded to 1.8% of that population, and the amount of missing OGTTs represented 13.8% of the group. Prevalence in the population of GI and HD- patients was 11% and 2.9% respectively. Only one case of HD+ was diagnosed over the 4 years of screening. Adapted dietary management was proposed to 80.4% of the GI patients and 93.3% of the HD- patients. Blood glucose monitoring was proposed to 42.9% of the GI patients and 84% of the HD- patients. Insulin administration was initiated for only 2 patients during the monitoring. Detailed analysis of each year showed an improvement of the screening and managing over time. Conclusion: The trend towards improvement of the professional practices can be explained by the appropriation by the medical profession of the recommendations. A more respectful application of the protocol would optimize even more the screening. In a second phase, we will consider an adaptation of the screening protocol with the new available tools (analysis of OGTT at T60 time and continuous glucose monitoring systems), which enable the diagnosis of carbohydrate metabolic disorders in complex situations.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01089090
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Monday, December 1, 2014 - 10:23:56 AM
Last modification on : Wednesday, August 23, 2017 - 4:30:32 PM
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Sandra Pochelu. Évaluation des pratiques professionnelles de dépistage et de prise en charge du diabète chez les enfants atteints de mucoviscidose à Bordeaux. Médecine humaine et pathologie. 2014. ⟨dumas-01089090⟩

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