Diabetes Care in French Guiana: The Gap Between National Guidelines and Reality

IntroductionFrench Guiana is a multicultural overseas territory in the Amazon, where precariousness and difficulties in access to care are widespread. The prevalence of diabetes is double that of other French departments, and cardiovascular morbidity and mortality is high. The objective of the study was to analyze the biological, clinical and therapeutic follow-up of patients with diabetes mellitus using exhaustive data and to correlate it with national and European recommendations.Material and MethodsUsing the national health insurance data, 9079 and 10075 patients with diabetes mellitus were analyzed in 2018 and 2019, respectively. We analyzed antidiabetic treatments, medical, dental, and podiatric consultations, examinations prescribed as part of the annual follow-up, and home nursing care.ResultsThere was a significant increase over one year in the number of patients (+10%) with diabetes, mainly women (60%), and 31% were under 54 years of age, with a disparity depending on the area of the territory, the most isolated having less access to screening. Less than 56% of patients had HbA1c measurements twice a year, less than 43% had an annual renal check-up, only 19% had an ophthalmic check-up at least every two years, less than 25% had an annual dental check-up, and less than 4% had an annual follow-up with the podiatrist.ConclusionsSubstandard diabetes monitoring is a major problem likely to increase morbidity and mortality. Adapting health care to the specificities of the territory is crucial, notably by formalizing the delegation of care to advanced practice nurse and non-healthcare professionals in precarious or geographically isolated areas.

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The Need for a More Stringent LDL-C Goal in Patients with Diabetes

Journal of Pharmacy Technology ◽

10.1177/875512250502100603 ◽

2005 ◽

Vol 21 (6) ◽

pp. 325-329

Author(s):

Julie S Altman ◽

Jessica L Kerr ◽

Margaret R Thrower

Keyword(s):

Diabetes Mellitus ◽

Relevant Literature ◽

Cardiovascular Morbidity ◽

Morbidity And Mortality ◽

Lipid Lowering ◽

Diabetic Patients ◽

Lipid Lowering Therapy ◽

Lipid Management ◽

Cardiovascular Morbidity And Mortality ◽

Patients With Diabetes

Objective: To review relevant literature supporting the need for intensive lipid management in patients with diabetes mellitus. Data Sources: A literature search using MEDLINE (1975–March 2005) was conducted. The search terms coronary disease, diabetes mellitus, hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins), lipoproteins, and low-density lipoprotein cholesterol (LDL-C) were used to identify published trials comparing the effects of intensive LDL-C lowering and cardiovascular morbidity and mortality. Study Selection and Data Extraction: Primary literature was evaluated and included in this review if the study was a large randomized trial containing a significant number of diabetic patients receiving primary prevention. For trials including patients without diabetes, an available sub-analysis of the diabetic population in that trial must have been available. Data Synthesis: The incidence of diabetes mellitus is rising in dramatic proportions throughout the nation. In addition to the diagnosis of diabetes, many of these patients also have preexisting risk factors that increase their risk for cardiovascular morbidity and mortality. In 2004, the National Cholesterol Education Program issued a scientific statement proposing a newer and lower optimal LDL-C goal for high-risk populations. This article reviews pertinent findings from recent clinical trials and guidelines discussing the need to integrate more stringent LDL-C goals into clinical practice. Conclusions: Although data are limited, all patients with diabetes mellitus, regardless of cardiovascular status, may benefit from lipid-lowering therapy with an optimal LDL-C goal of < 70 mg/dL.

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Soluble CD40 Ligand Is Predictive of Cardiovascular Morbidity and Mortality at Two-Year Follow-Up in Patients on Haemodialysis From North-Western Tuscany

High Blood Pressure & Cardiovascular Prevention ◽

10.2165/00151642-200714030-00119 ◽

2007 ◽

Vol 14 (3) ◽

pp. 145-196

Author(s):

G B Desideri ◽

L Ghiadoni ◽

F Cipollone ◽

A Mezzetti ◽

G Passacquale ◽

...

Keyword(s):

Cd40 Ligand ◽

Cardiovascular Morbidity ◽

Morbidity And Mortality ◽

Soluble Cd40 Ligand ◽

Cardiovascular Morbidity And Mortality ◽

North Western

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Short-term and long-term follow-up of patients with diabetes mellitus with minor amputations

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2008.03.041 ◽

2008 ◽

Vol 23 (5) ◽

pp. 697-698

Author(s):

Vadim B. Bregovsky ◽

Tatiana L. Tsvetkova

Keyword(s):

Diabetes Mellitus ◽

Short Term ◽

Patients With Diabetes ◽

Long Term Follow Up

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TCT-507: One-year Mortality in Patients with Diabetes Mellitus Undergoing PCI: Pooled Analysis from the REPLACE-2, ACUITY, and HORIZONS-AMI Trials

The American Journal of Cardiology ◽

10.1016/j.amjcard.2009.08.538 ◽

2009 ◽

Vol 104 (6) ◽

pp. 187D

Keyword(s):

Diabetes Mellitus ◽

Pooled Analysis ◽

Patients With Diabetes ◽

One Year

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Minimally Invasive versus Open Thoracolumbar Surgery for Lumbar Spinal Stenosis in Patients with Diabetes: A CSORN Study

Journal of Spine Practice (JSP) ◽

10.18502/jsp.v1i1.9773 ◽

2021 ◽

pp. 13

Author(s):

Kalpesh Hathi

Keyword(s):

Back Pain ◽

Minimally Invasive ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Research Network ◽

Leg Pain ◽

Number Of Patients ◽

Patients With Diabetes ◽

One Year ◽

Lumbar Spinal

Introduction: This study was aimed at comparing outcomes of minimally invasive (MIS) versus OPEN surgery for lumbar spinal stenosis (LSS) in patients with diabetes. Methodology: This retrospective cohort study included patients with diabetes who underwent spinal decompression alone or with fusion for LSS within the Canadian Spine Outcomes and Research Network (CSORN) database. Outcomes of MIS and OPEN approaches were compared for two cohorts: (i) patients with diabetes who underwent decompression alone (N = 116; MIS, n = 58, OPEN, n = 58) and (ii) patients with diabetes who underwent decompression with fusion (N = 108; MIS, n = 54, OPEN, n = 54). Mixed measures analyses of covariance compared modified Oswestry Disability Index (mODI) and back and leg pain at one-year post operation. The number of patients meeting minimum clinically important difference (MCID) or minimum pain/disability at one year were compared. Result: MIS approaches had less blood loss (decompression alone difference 99.66 mL, p = 0.002; with fusion difference 244.23, p < 0.001) and shorter LOS (decompression alone difference 1.15 days, p = 0.008; with fusion difference 1.23 days, p = 0.026). MIS compared to OPEN decompression with fusion had less patients experience an adverse event (difference, 13 patients, p = 0.007). The MIS decompression with fusion group had lower one-year mODI (difference, 14.25, p < 0.001) and back pain (difference, 1.64, p = 0.002) compared to OPEN. More patients in the MIS decompression with fusion group exceeded MCID at one year for mODI (MIS 75.9% vs OPEN 53.7%, p = 0.028) and back pain (MIS 85.2% vs OPEN 70.4%, p = 0.017). Conclusion: MIS approaches were associated with more favorable outcomes for patients with diabetes undergoing decompression with fusion for LSS.

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VITAMINS. PREVENTION AND TREATMENT OF COMPLICATIONS IN PATIENTS WITH DIABETES MELLITUS

Medical Council ◽

10.21518/2079-701x-2017-3-95-98 ◽

2017 ◽

pp. 95-98

Author(s):

S. V. Podachina

Keyword(s):

Diabetes Mellitus ◽

Glycemic Control ◽

Optimal Level ◽

Number Of Patients ◽

Prevention And Treatment ◽

Patients With Diabetes

Hyperglycemia is a major cause of complications in patients with diabetes mellitus (DM). Since the optimal level of glycemic control is achieved only in a small number of patients with diabetes mellitus, additional methods of prevention and treatment of complications are strongly recommended. The focus of healthcare specialists is increasing on substances that can affect intracellular pathological processes associated with hyperglycemia. Such drugs or agents include certain vitamins and minerals.

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Therapeutic guidelines for the treatment of cystic fibrosis

Pharmacia ◽

10.3897/pharmacia.68.e49247 ◽

2021 ◽

Vol 68 (1) ◽

pp. 151-154

Author(s):

Maria Becheva ◽

Petar Atanasov

Keyword(s):

Cystic Fibrosis ◽

Autosomal Recessive ◽

Autosomal Recessive Disease ◽

Clinical Evaluations ◽

Number Of Patients ◽

Therapeutic Guidelines ◽

Therapeutic Measures ◽

One Year ◽

Respiratory Rehabilitation

Cystic fibrosis (CF) is a complex, systemic autosomal recessive disease that affects the functions of the respiratory system, the digestive tract and all exocrine glands. The frequency for Europe averages 1: 2500 to 1: 3500 live births. The total number of patients with cystic fibrosis in Bulgaria is about 180. About 10% of the patients are diagnosed at birth. About 60–70% of patients are diagnosed before they reach one year of age. Respiratory symptoms predominate in the clinical picture in patients with cystic fibrosis and determine the prognosis in more than 90% of the patients. The treatment of patients with cystic fibrosis is strictly individualized, pharmacological and non-pharmacological and requires a comprehensive therapeutic approach. The complex therapy also includes bronchodilators, NSAIDs, corticosteroids, respiratory rehabilitation in combination with general body massage. Continued courses of broad-spectrum antibiotics are required to suppress chronic infection. With the progression of the disease, complications such as atelectasis, pneumothorax and pulmonary hemorrhages are observed. The establishment of specialized centers with trained and experienced professionals is essential in order to provide optimal patient care. These include frequent clinical evaluations, follow-up of complications, and early interventions for the treatment of patients with cystic fibrosis. The aim of the article is to familiarize the audience with the therapeutic measures applied in the treatment of patients with cystic fibrosis.

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Endocrine Disorders in a Specialized Hospital in Guyana

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2019/v30i1230267 ◽

2019 ◽

pp. 30-31

Author(s):

Yaquelin Gonzalez Ricardo ◽

Yaritza Lopez Diaz ◽

Ravendra Johnaton Dudnauth ◽

Maritza Oliva Perez

Keyword(s):

Diabetes Mellitus ◽

Pituitary Tumors ◽

Obstetric Care ◽

Endocrine Disorders ◽

Patients With Diabetes ◽

Sheehan Syndrome ◽

One Year ◽

The One ◽

Low Prevalence ◽

Endocrinology Clinic

Background: Endocrine diseases are characterized by hormonal alterations (excess or defect). Due to the low prevalence (less than five case 5 / 10 000 inhabitants), a large number of them, qualify to be classified as rare diseases such as those of organs like: hypophysis, adrenal glands, gonads as well as some congenital thyroid diseases. Others like Diabetes are considering almost epidemic. Objective: To define the types of diseases observed in the only Endocrinology Clinic in Guyana. Methods: The diagnoses of all patients who attended the endocrinology clinic of the Georgetown Public Hospital Corporation from June 1, 2016 to May 31, 2017, were analyzed. Results: During the one year of this study, approximately 639 patients attended the endocrinology clinic. Of this, 178 patients had thyroid-related diseases with 80 of these having thyrotoxicosis, 49 having hypothyroidism followed by 110 patients with diabetes mellitus. Pituitary tumors were also diagnosed with 2 of acromegaly and 6 of prolactinomas. Cases of hypoadrenalism (n = 5), hypogonadism (n = 4), and pheochromocytoma (n = 6) were not rare; gonadal disease were also found in 17 patients. Thyroid disease was the most frequent diagnosis followed by diabetes mellitus. New emerging endocrine disorders such as hyperlipidemia (n = 1) were rare. Some persons attending the clinic were also noted to be overweight /obese however this was not the primary reason for joining the clinic. Traditional diseases such as Sheehan Syndrome have become rare due to improvements in Obstetric care.

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Improved Biochemical Parameters in Patients Who Undergo Early Resection in Isolated Ileocaecal Crohn’s Disease

Surgery Research and Practice ◽

10.1155/2017/4396573 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5

Author(s):

Mirzafaraz Saeed ◽

Hari Hullur ◽

Amro Salem ◽

Abbas Ali ◽

Yousif Sahib ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Surgical Resection ◽

Complete Blood Count ◽

Long Term Results ◽

Number Of Patients ◽

Long Term Follow Up ◽

One Year

Introduction. The aim of this study is to evaluate the outcome of introduction of early surgery in the course of isolated ileocecal Crohn’s disease, where there is no absolute indication of surgery. Methods. Observational study involving patients with isolated ileocecal Crohn’s disease who underwent early surgical resection (within one year of the presentation of the hospital). A complete blood count, ESR, and CRP were done and compared between the preoperative value, 1st postoperative visit (3-4 weeks), and last follow-up visit. Statistical analysis was done using Analysis of Variance (ANOVA) to compare the different figures. Results. There was a statistically significant increase in the hemoglobin levels between preoperative, postoperative, and long-term follow-up and a significant decrease in leukocyte count between the pre- and postoperative values (F=19.8, p<0.001 and F=8.9, p=0.002, resp.). Similarly, the ESR and CRP values were decreased significantly at long-term follow-up (F=8.5, p=0.019 and F=8.3, p=0.013, resp.). Conclusion. Early surgical resection in isolated ileocaecal Crohn’s disease achieved significant biochemical improvements. These successful results in this small number of patients indicate that early surgical intervention may provide better outcomes. These initial results encourage larger and comparative studies of long-term results versus long-term use of biological agents.

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