État des lieux de la prise en charge du diabète de type 1 de l’enfant dans la Nouvelle Aquitaine : une évaluation comparative des équilibres métaboliques au regard des moyens humains et techniques disponibles par centres hospitaliers

Abstract : Background: the role of elevated levels of HbA1c is known for the prediction of vascular complications in patients with type 1 diabetes (T1D). Benchmarking in pediatric diabetology is supposed to lead to an improvement in patients care, focusing on the relationship between current diabetes management and center differences in metabolic outcomes. Objectives: to investigate whether regional disparities exist in pediatric diabetes care. To check if good glycemic control is achieved according to International Society of Pediatric and Adolescent Diabetes (ISPAD) guidelines (HbA1c<7,5%). Methods: a multicenter study was carried out with liberal and hospital pediatricians in “Nouvelle Aquitaine”: newly diagnosed cases of T1D were collected. Then, mean HbA1c, insulin regimens, number of HbA1c testing were recorded in a cross-sectional study for each child in 2017, results were compared between centers. Finally, pediatricians were asked to answer a survey about health care professional number they had access to. Results: there were 863 newly diagnosed cases in 13 centers from 2010 to 2017, with an increase of 3,0±1,3%/year in Bordeaux unit. There was an increase in the ratio of children under the age of 5 of 0,5±0,2%/year. 1074 T1D children with diabetes duration >15 months were included in 15 centers (mean age: 12,8±3,7y, mean diabetes duration: 5,8±3,5y, 55% males). Mean HbA1c (8,1±1,1%, range: 7,8±0,8% - 8,6±1,6%) differed significantly between centers (p=0,01), insulin regimens and number of HbA1c testings did not explain these differences. Only 27,5% had HbA1C<7,5%. Per 100 patients, diabetes care was ruled out by 0,39 physicians (range: 0,23-1,43), 0,15 nurses (range: 0-0,56), 0,12 dieteticians (range: 0-0,23) and 0,07 psychologists (range: 0-0,30). Conclusions: health care professional workforce to 100 patients ratio remained below the international recommendations. Metabolic outcome in “Nouvelle Aquitaine” was below ISPAD recommendations in the majority of patients.
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Master Thesis
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Marie-Neige Campas-Lebecque. État des lieux de la prise en charge du diabète de type 1 de l’enfant dans la Nouvelle Aquitaine : une évaluation comparative des équilibres métaboliques au regard des moyens humains et techniques disponibles par centres hospitaliers. Médecine humaine et pathologie. 2018. ⟨dumas-02091569⟩

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