[Hospital to home transition of care: challenges for patients with type 2 diabetes]. / Transition hôpital-ambulatoire : les enjeux pour les patients avec un diabète sucré.

The transition from hospital to ambulatory care is a high-risk period for patients with diabetes mellitus and is a challenge for health care professionals. Various interprofessional collaborative interventions have shown a positive impact on continuity of care at discharge. Communication and transmission of information between the hospital and ambulatory settings as well as coordination between healthcare professionals are key points to explore and to improve to ensure optimal continuity of care.

La transition entre l'hôpital et l'ambulatoire est une période à risque pour les patients avec un diabète sucré et un enjeu pour les professionnels de la santé. Différentes interventions en collaboration interprofessionnelle ont montré un impact positif sur la continuité des soins à la sortie de l'hôpital. La communication et la transmission d'informations entre les milieux hospitalier et ambulatoire ainsi qu'une coordination entre les professionnels de la santé sont des points clés à explorer et à continuer d'améliorer pour garantir une continuité des soins optimale.

Global Inequality in Type 1 Diabetes: a Comparison of Switzerland and Low-and Middle-Income Countries.

Globally it is estimated that over 1 million children and adolescents have Type 1 diabetes with large variations in incidence between different contexts. Health systems need to provide a variety of elements to ensure appropriate diabetes care, such as service delivery; healthcare workforce; information; medical products and technologies; financing and leadership and governance. Describing these elements between Geneva, Switzerland, a high-income country with high spending on healthcare and a large density of doctors, and low- and middle-income countries this article aims to highlight the global inequality of diabetes care. Type 1 diabetes can serve as a litmus as we move towards the centenary of the discovery of insulin and beyond as there is a need for a global movement to ensure that innovation in the management of diabetes benefits the whole diabetes community and not just a select few.

[Diabetes mellitus: impact of affects on self-management skills]. / Diabète sucré: impact des affects sur les compétences d'autogestion.

Diabetes self-management (DSM) is a process based on a series of complex learnings. The conceptualization of the role of the emotional dimensions that underlie and structure this process is critical to better understand why living with diabetes can become a burden. A clinical case illustrates the intertwining of the affective and cognitive dimensions of diabetes burden and its influence on DSM skills. Emotional regulation is a recognized determinant to implement effective and long-term DSM skills as well as access to DSM interventions. In order to improve DSME/S interventions efficacy, the role of emotional dimensions, new technologies and therapeutic advances needs to be considered.

L'autogestion du diabète sucré (AGDM) est un processus basé sur une série d'apprentissages complexes. La conceptualisation du rôle des dimensions affectives qui sous-tendent et structurent ce processus permet d'appréhender différemment le vécu des patients avec un diabète sucré. Une vignette clinique illustre l'intrication des dimensions affectives et cognitives et les possibles conséquences sur l'AGDM. La régulation des émotions s'avère être un des facteurs déterminants de l'AGDM, tout comme l'accès à des dispositifs d'éducation thérapeutique du patient (ETP). La prise en compte du rôle respectif des dimensions émotionnelles, des nouvelles technologies et des avancées thérapeutiques sur l'AGDM est à considérer pour développer des dispositifs d'ETP performants.

An Intervention by a Patient-Designed Do-It-Yourself Mobile Device App Reduces HbA1c in Children and Adolescents with Type 1 Diabetes: A Randomized Double-Crossover Study.

BACKGROUND: Prevention of type 1 diabetes mellitus (T1DM)-related complications is dependent on metabolic control. The recommended glycated hemoglobin (HbA1c) values <7.5% (58.5 mmol/mol) are met only by a minority of diabetic children and especially adolescents. The aim of this study was to evaluate the impact of an intervention comprising the use of Webdia, a patient-designed app for smartphones, on metabolic control of T1DM in children. METHODS: Fifty-five patients with T1DM, 10-18 years of age, were included in this single-center, randomized double-crossover study. We tested an intervention consisting of using Webdia for 3 months with monthly feedback and adaptation of the treatment. Main outcome was modification of HbA1c. Secondary outcomes were the prevalence of hypoglycemia and quality of life (QoL). RESULTS: Of the 55 included patients, 33 completed the study, 9 dropped out, and 13 were excluded due to insufficient use of the app. The app was well accepted by the users who completed the study (46.4% rated the program as good and 39.3% as excellent). The intervention led to a reduction of HbA1c by 0.33%, compared to the control group in which HbA1c rose by 0.21% (P = 0.048) in patients with HbA1c values >8.0% (63.9 mmol/mol) at inclusion, without increasing the prevalence of hypoglycemia (8.52 ± 9.45 hypoglycemic events during last 2 weeks of intervention vs. 7.62 ± 6.37 observation, P = 0.680). QoL scores were not modified. CONCLUSIONS: The intervention resulted in a significant decrease in HbA1c, without increasing the prevalence of hypoglycemia in patients with initial HbA1c >8.0% (63.9 mmol/mol).