[Modalities of follow-up on non-insulin treated diabetics treated in metropolitan France in 1998].
The statistical analysis of French HealthCare's database allows a retrospective evaluation of the overall clinical care given to diabetics in the light of the guidelines (RBPC) promulgated by the National Agency of Health Accreditation and Evaluation (ANAES). This database contains no information on the stage of the disease process, the completeness of the clinical evaluation (neurological or foot examination) or the results of significant blood tests. We studied the follow-up care given to diabetics whom we were able to identify by isolating reimbursements for hypoglycemic agents using their corresponding drug codes. Considering the time needed for this new drug-coding system to become fully operational, the results can be extrapolated to the entire population of non-insulin treated diabetics. In 1998, almost all follow-up care was provided by general practitioners since only 5.5 % of the patients consulted an endocrinologist during the year studied. Blood sugar was generally monitored with fasting blood sugars rather than HbA1c which was only prescribed in 41.3 % of the patients during the final six months of the period under consideration. Screening and follow-up for degenerative complications were insufficient. Fewer than 40 % of the patients had received reimbursement for an ophtalmological consultation during the preceeding year and fewer than 30 % had an ambulatory resting EKG over the same time period. A certain number of factors were studied in order to determine if they were correlated to better clinical follow-up. The best follow-up was encountered in patients who had a consultation with an endocrinologist at least once during the year, those who were exonerated from co-payments (ALD 30) and finally, those aged between 40 and 59 years (at least with respect to appropriate laboratory tests).
Weill
A
A
Echelon National du Service Médical de l'Assurance Maladie (CNAMTS), CNAMTS. 66, Avenue du Maine, 75 694 Paris Cedex 14, France. alain.weill@cnamts.fr
Ricordeau
P
P
Vallier
N
N
Bourrel
R
R
Fender
P
P
Allemand
H
H
D001786:Blood Glucose / Q000032:analysis; D003253:Consultants; D019992:Databases as Topic; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D017408:Guidelines as Topic; D006801:Humans; D015994:Incidence; D014504:Urban Health; D014505:Urban Population / Q000706:statistics & numerical data*
D001786:Blood Glucose; D006442:Glycated Hemoglobin