[Results from a community based diabetic foot screening campaign]. / Résultats d'une campagne de dépistage du pied diabétique.

A community-based diabetic foot screening campaign was introduced during one week in the French-speaking part of Switzerland to emphasize the preventive impact of systematic foot inspections. Of 494 screened people, 46 % never had their feet checked - and as many as 63% if only standardized examinations according to the recommendations are considered. The risk of diabetic foot complications may appear as early as a few years after diagnosis, underlining the importance of a systematic annual check-up.

Une campagne de dépistage gratuit du pied diabétique a été organisée en Suisse romande pendant une semaine afin de sensibiliser les personnes diabétiques à l'importance de contrôles réguliers des pieds et d'améliorer l'accès aux soins pour tous. Sur les 494 personnes dépistées, 46 % n'avaient pas eu de contrôle préalable des pieds ­ et même 63 % si l'on ne considère que les examens réalisés selon les standards recommandés. Les risques de complication peuvent apparaître dès les premières années suivant le diagnostic, soulignant l'importance d'un contrôle annuel systématique.

[Non-communicable diseases and vulnerable populations: overview of the situation and vision for the future]. / Maladies chroniques et populations vulnérables : état des lieux et vision d'avenir.

The care of vulnerable people with non-communicable diseases faces numerous barriers including difficulties in identifying affected people, lack of time, resources, tools and skills to address these issues, poor intersectoral work between health-care and social work. We plea for a systematic public policy which allows to implement intersectoral collaborations at all levels.

La prise en charge des personnes vulnérables vivant avec des maladies chroniques rencontre de nombreuses difficultés, dont l'identification des populations concernées, le manque de temps, de ressources, d'outils et de compétences pour traiter ces questions et l'insuffisance du travail intersectoriel entre la santé et le social. Une politique publique systématique est nécessaire pour mettre en œuvre des collaborations intersectorielles à tous les niveaux.

[Cantonal diabetes Program - a response at local level to address public health issues related to non-communicable diseases]. / Programme cantonal Diabète Vaud - Une réponse aux enjeux de santé publique liés aux maladies chroniques à l'échelle d'un canton.

In 2010 the canton of Vaud has innovated by launching the Cantonal Diabetes Program (PcD) aimed at reducing the impact of diabetes on the population. The evaluation after 7 years shows that some clinical examinations are performed more regularly and lower limb amputations tend to decrease. The contributions and interprofessional collaborations resulting from the PcD provide concrete guidelines for the implementation of a more comprehensive strategy of prevention and management of non-communicable diseases. It should be developed according to a chronicity model integrating social vulnerability.

Les autorités sanitaires du canton de Vaud ont innové en lançant en 2010 le Programme cantonal Diabète (PcD) dans le but de diminuer l'impact du diabète sur la population vaudoise. Le bilan réalisé après sept ans montre une amélioration de certains contrôles systématiques et une diminution des amputations des membres inférieurs. Les contributions et les collaborations interprofessionnelles résultant du programme fournissent des pistes concrètes pour la mise en œuvre d'une stratégie plus globale de prévention et prise en charge des maladies non transmissibles. Elle devrait se développer selon un modèle de chronicité intersectoriel intégrant notamment la vulnérabilité sociale.

[Virtual reality: a tool that can be used in outpatient diabetes services]. / Réalité virtuelle : un outil utilisable en consultation diabétologique.

Health-related emerging technologies are growing fast. The use of virtual reality in diabetes outpatient care still remains unprecedented, notably in Switzerland. Thus, the Programme cantonal Diabète led a pilot study to assess the feasibility of an immersive application in such an outpatient setting. Results emphasize that this device is practicable and useful in diabetes care. Patients and their relatives overall appreciate the game, each of them for specific reasons: playful quality, opportunity to « learn differently ¼ or to exchange about the subjective experience. Furthermore, there is no restraint (age, language, educational level…) in the ability to use such a device, except for emerging technologies habit.

L'utilisation des nouvelles technologies en lien avec la santé est en plein essor. L'usage de la réalité virtuelle en consultation diabétologique reste cependant un domaine inédit, notamment en Suisse. Partant de ce constat, le Programme cantonal Diabète a mené une étude-pilote, questionnant la faisabilité de l'emploi d'une application immersive dans le domaine des soins. Les résultats montrent que l'utilisation du dispositif testé est envisageable et utile. Le jeu est globalement très bien reçu par les patients et leurs proches, chacun y trouvant un apport spécifique : côté ludique, possibilité d'apprendre autrement ou encore de dialoguer sur le vécu subjectif. En outre, aucune des caractéristiques (âge, langue maternelle …) n'entrave la capacité d'utilisation d'un tel dispositif, si ce n'est l'habitude des nouvelles technologies.

Awareness and practices regarding eye diseases among patients with diabetes: a cross sectional analysis of the CoDiab-VD cohort.

BACKGROUND: The increasing prevalence of diabetes is leading to a rise of eye diseases, augmenting the risk of sight-threatening complications. The aim of this study was to evaluate prevalence, awareness and practices regarding eye diseases among patients with diabetes in the canton of Vaud, Switzerland. METHODS: A cohort of 323 patients with diabetes completed a self-administered questionnaire assessing prevalence, awareness and practices regarding eye diseases, besides health status and quality of care measures. Descriptive analyses followed by exploratory subgroup analyses and linear regressions were performed to investigate factors associated with awareness and practices. RESULTS: While diabetic retinopathy was reported by 40.9% of patients with type 1 diabetes and 9.8% of patients with type 2 diabetes, 35.8% and 12.6% of all participants reported cataract and glaucoma, respectively. Awareness that diabetes could damage the eyes was reported by almost all participants; the majority was also aware of the importance of glycemic control and regular eye examination in preventing eye diseases. In contrast, only 70.5% of participants underwent an eye examination by an ophthalmologist during the past year. Eye examination was associated with better patients' awareness. Barriers mentioned by patients revealed a lack of knowledge about screening guidelines, in particular regarding the preventive nature of eye examinations. CONCLUSIONS: Despite high levels of awareness regarding diabetic eye diseases, a significant proportion of patients with diabetes did not report annual eye examination. Both healthcare strategic efforts targeting the promotion of regular eye examination and initiatives aiming at improving knowledge of screening guidelines should be encouraged. TRIAL REGISTRATION: ClinicalTrials.gov on 9th July 2013, identifier NCT01902043 (retrospectively registered).

[Preventive measures of diabetic foot complications]. / Prévention des complications du pied diabétique.

Diabetic foot complications are a public health challenge and preventive measures although simple are often not enforced, as evidenced by the lack of decrease in the rate of ulcers and amputation in Switzerland. This article proposes a risk score to grade individual risk of the diabetic patient and an individualized prevention measures as this risk. We discuss the importance of collaboration of various specialists. Two areas are important, first the early involvement of specialists in revascularization because the diabetic population with feet at risk of ulcération risk nowadays primarily has neuro-ichemic ulcerations and also the close collaboration with podiatrists and orthopedic shoemakers who are full partners of the multidisciplinary team.

[Pediatric diabetes health Service from East canton of Vaud : towards a model of proximity care delivery ?] / Filière diabéto-pédiatrique de l'Est vaudois : vers une modélisation des soins de proximité ?

Learning to live with a chronic condition is one of the greatest challenges regarding health today, either at individual or societal level. Type 1 diabetes affecting young people and their family raises new care delivery. Proximity structures, inserted into the regional network, accessible and responsive to the needs of patients and their families, are thus promising to encourage empowerment in persons affected by a chronic disease as well as in their entourage.

Apprendre à vivre avec une maladie chronique est un des défis majeurs auxquels est confronté le monde de la santé aujourd'hui, tant au plan de l'individu que de la société dans son ensemble. Le diabète de type 1, qui touche des individus jeunes et leur entourage, suscite le développement de nouvelles offres de soins. Ainsi, des structures de proximité, insérées dans le réseau régional, faciles d'accès et répondant aux besoins des patients et de leur entourage, sont prometteuses car elles favorisent le processus d'autonomisation tant chez les personnes concernées que leur entourage.

Baseline data of a population-based cohort of patients with diabetes in Switzerland (CoDiab-VD).

QUESTIONS UNDER STUDY: To describe a population-based sample of patients with diabetes and the quality of their care in the canton of Vaud, Switzerland, as a baseline measure for the evaluation of the "Programme cantonal Diabète". METHODS: We conducted a self-administered paper-based questionnaire survey. Non-institutionalised adult (aged ≥18 years) patients with diabetes diagnosed for at least 1 year and residing in the canton of Vaud were recruited by community pharmacies. Women with gestational diabetes, people with obvious cognitive impairment or people not sufficiently fluent in French were excluded. Primary outcomes were recommended processes-of-care and outcomes of care (glycosylated haemoglobin [HbA1c], generic and disease-specific health-related quality of life (HRQoL), overall care score in relation to the Chronic Care Model). Other measures included diabetes education, self-management support and self-efficacy, health status, health behaviour and demographics. RESULTS: A total of 519 patients with diabetes were included. Whereas the mean HbA1c level was 7.3% (n = 177, 95% confidence interval 7.1-7.5), diabetes-specific processes-of-care and influenza vaccination were reported by less than two-thirds of the patients. Physical activity and diet recommendations results mirrored patients' difficulties with their management in daily life and diabetes-specific HRQoL was worst in the dimensions relative to diet (eating and drinking) and sex life. A minority of patients reported ever having participated in diabetes education courses (32.8%). Overall, patients were satisfied with their care and the support they received. CONCLUSIONS: This study provides a broad picture of the experiences of people living with diabetes in the canton of Vaud. It shall guide the development of targeted interventions within the "Programme cantonal Diabète".

Impact and cost of a 2-week community-based screening and awareness program for diabetes and cardiovascular risk factors in a Swiss canton.

BACKGROUND: Community-based diabetes screening programs can help sensitize the population and identify new cases. However, the impact of such programs is rarely assessed in high-income countries, where concurrent health information and screening opportunities are common place. INTERVENTION AND METHODS: A 2-week screening and awareness campaign was organized as part of a new diabetes program in the canton of Vaud (population of 697,000) in Switzerland. Screening was performed without appointment in 190 out of 244 pharmacies in the canton at the subsidized cost of 10 Swiss Francs per participant. Screening included questions on risk behaviors, measurement of body mass index, blood pressure, blood cholesterol, random blood glucose (RBG), and A1c if RBG was ≥7.0 mmol/L. A mass media campaign promoting physical activity and a healthy diet was channeled through several media, eg, 165 spots on radio, billboards in 250 public places, flyers in 360 public transport vehicles, and a dozen articles in several newspapers. A telephone survey in a representative sample of the population of the canton was performed after the campaign to evaluate the program. RESULTS: A total of 4222 participants (0.76% of all persons aged ≥18 years) underwent the screening program (median age: 53 years, 63% females). Among participants not treated for diabetes, 3.7% had RBG ≥ 7.8 mmol/L and 1.8% had both RBG ≥ 7.0 mmol/L and A1c ≥ 6.5. Untreated blood pressure ≥140/90 mmHg and/or untreated cholesterol ≥5.2 mmol/L were found in 50.5% of participants. One or several treated or untreated modifiable risk factors were found in 78% of participants. The telephone survey showed that 53% of all adults in the canton were sensitized by the campaign. Excluding fees paid by the participants, the program incurred a cost of CHF 330,600. CONCLUSION: A community-based screening program had low efficiency for detecting new cases of diabetes, but it identified large numbers of persons with elevated other cardiovascular risk factors. Our findings suggest the convenience of A1c for mass screening of diabetes, the usefulness of extending diabetes screening to other cardiovascular risk factors, and the importance of a robust background communication campaign.