title: Quality of care of patients with type 1 diabetes: population-based results in a French region.
abstract: OBJECTIVE
  Although the incidence of type 1 diabetes (T1D) has been increasing, little is known of its quality of care. Thus, our survey was designed to retrospectively evaluate this issue in French patients.
  
  
  METHODS
  Patients with T1D living in northeastern France were identified thanks to the healthcare system (CPAM) database, and the resulting list reviewed by local diabetes specialists. All of the listed patients and their primary physicians were asked to fill in a questionnaire including clinical data, laboratory results and follow-up habits. The 'optimized results' included CPAM-based results plus any specialized care provided during hospitalizations in diabetes and non-diabetes units, according to questionnaire data.
  
  
  RESULTS
  A total of 227 individuals, for whom CPAM data were available, were identified as having T1D. From these patients, 174 questionnaires were answered, and optimized results (having both CPAM data and a completely filled-in questionnaire) were available for 149 patients. Of the 169 patients who responded, 71.3% reported at least a yearly visit with a diabetologist. This number reached 77.9% when optimized results were considered. Patients who received specialized care were younger, underwent HbA(1c) tests more often and were more frequently on optimal treatment; however, there was no difference in HbA(1c) values or in the prevalence of complications. Eye examinations and kidney tests had been performed at least once over the 2-year period in more than 87% of the patients, whereas around 30%, 21% and 23% had an eye exam, creatinine test and urinary albumin excretion measurement, respectively, only once over the same time period.
  
  
  CONCLUSIONS
  This is the first large-scale study of the quality of care in patients with T1DM in France, and it could serve as a preliminary survey for a national study. Although the follow-up was better than previously reported, there is still considerable room for improvement.
authors: Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean-Minjoz Hospital, EA 3920, University of Franche-Comté, 25030 Besançon cedex, France. alfred.penfornis@univ-fcomte.fr
authors: A
authors: A
authors: Penfornis
authors: E
authors: E
authors: Personeni
authors: M
authors: M
authors: Tiv
authors: C
authors: C
authors: Monnier
authors: L
authors: L
authors: Meillet
authors: J
authors: J
authors: Combes
authors: C
authors: C
authors: Mouret
authors: S
authors: S
authors: Picard
mesh_terms: D000328:Adult; D017668:Age of Onset; D000419:Albuminuria / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D003404:Creatinine / Q000378:metabolism; D048909:Diabetes Complications / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D005602:France / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006306:Health Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D011787:Quality of Health Care; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D003404:Creatinine; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human