Risk factors for hypoglycaemia in people with diabetes admitted to the Emergency Department of a Hospital in French Guiana.

AIMS/INTRODUCTION: Strict management of glucose levels in elderly people with diabetes or with comorbidities exposes them to the risk of severe hypoglycaemia (capillary or venous glucose ≤3.3 mmol/L) and the associated morbidity and mortality. We aimed to describe the clinical, laboratory, and epidemiological characteristics of people with diabetes admitted to the Emergency Department in Cayenne, French Guiana for severe hypoglycaemia and identify avoidable behaviours in this population. MATERIALS AND METHODS: An observational epidemiological study of adults with diabetes who presented to the Emergency Department with severe hypoglycaemia was conducted between 2015 and 2018. Their medical history, clinical and laboratory data were collected. The primary outcome was the association between therapeutic misuse and age ≥65 years. RESULTS: Overall, 178 admissions were analysed. The main cause of hypoglycaemia was insulin dosing-error or inappropriate glycaemic targets. Among those ≥65 years, 59% had a glycated haemoglobin ≤48 mmol/mol (6.5%), and the median duration of their diabetes was 20 years. Among them, 60% were treated with sulfonylurea, repaglinide, biphasic insulin, or mixed drugs, and 48% were on non-diabetes related treatments that had a hypoglycaemic effect. Furthermore, 23% of the elderly treated with oral antidiabetics had chronic kidney disease. CONCLUSION: Many avoidable risk factors for severe hypoglycaemia have been highlighted, in particular insulin dosing errors or non-compliance with recommendations for participants ≥ 65 years. Primary care physicians and homecare nurses need to provide preventive interventions and undergo training.

Nutritional and Socioeconomic Determinants of Overweight and Obesity in the French Amazon: The Health Barometer Study.

Objectives: French Guiana is a multicultural overseas territory where obesity is a major public health problem. This study aimed to highlight the nutritional and socioeconomic determinants of overweight and obesity in different populations in French Guiana. Methods: A two-stage random sample of 1390 individuals aged 15 to 75 years was surveyed by telephone, and the participants were initially screened for diabetes. Logistic regression was fitted on the sample to adjust for potential confounding factors. Results: Overweight and obesity were found in 54.7% of the respondents, a higher proportion than in mainland France. There was a significant body image discrepancy in our population, with a higher risk of obesity among single women, often immigrants from the non-French Caribbean and South America, unemployed or low education. Conclusions: The main factors associated with obesity were being a precariousness immigrant; there was often a mismatch between body image and overweight/obesity, which is a major obstacle to the improvement of dietary behaviors and lifestyle. This information provides operational clues as to where to act and the necessary adaptations to attempt to modify behaviors in a culturally-adapted manner.

Specificities of the Diabetic Population in French Guiana: The Health Barometer Survey.

AIM: This study aims to identify the epidemiological and social characteristics of the diabetic population in French Guiana. BACKGROUND: The prevalence of diabetes is very high in the French overseas departments. French Guiana is, however, a very atypical territory, closer in the epidemiological field to Latin America than European and French standards. OBJECTIVE: To perform a descriptive analysis of variables related to renouncing medical care, social parameters, and use of healthcare services. METHODS: A two-stage random sample of 1390 individuals aged 30 to 75 years was surveyed by telephone, and screening was initially done for diabetic versus non-diabetic individuals. Logistic regression was fitted on the sample to adjust for potential confounding factors. A Kaplan-Meier analysis showed the risk of diabetes as a function of the age of onset. RESULTS: The prevalence rate of diabetes was 9.3%, particularly among women, for whom 20% had a history of gestational diabetes. Excess weight and obesity were found in 60% of people with diabetes. The diabetic individuals in French Guiana were younger than those in mainland France, and 30% of people with diabetes were on insulin. They often reported sleep problems, and their health status was described as poor. People with diabetes did not regularly consult a doctor and were very rarely followed up by a specialist. CONCLUSIONS: The prevalence rate of diabetes and obesity in French Guiana was one of the highest among the French territories, with specific vulnerabilities requiring to be addressed by local health policies.

Vitamin D Deficiency in Patients with Diabetes in French Guiana: Epidemiology and Relation with Microvascular and Macrovascular Complications.

Vitamin D (VD) insufficiency is common among patients with diabetes in French Guiana. The study aimed to evaluate the prevalence of VD deficiency in the different type of diabetes encountered and to analyze the relationship between VD deficiency and diabetes complications. METHODS: An observational study was conducted between May 2019 and May 2020 in French Guiana, based on data from the CODIAM study (Diabetes Cohort in French Amazonia), describing the characteristics of patients with diabetes mellitus. Among 600 patients enrolled with diabetes, 361 had an available VD assay. RESULTS: The mean 25(OH)VD (hydroxycalciferol) level was 27.9 ng/mL. The level of VD was inversely proportional to the HbA1c (glycated hemoglobin) level. Patients with angina pectoris had a greater proportion of deficiencies VD < 20 ng/mL than those without angina. By contrast, patients with retinopathy had higher vitamin D concentrations than those without retinopathy. There was no association between vitamin D and arteriopathy, stroke, nephropathy and polyneuropathy. VD deficiency was more frequent in women, and in patients with a high school education. CONCLUSION: The prevalence of VD deficiency was high in patients with diabetes in French Guiana, emphasizing the importance of VD supplementation.