Do children and adolescents with type 1 diabetes suffer from a lack of resources in France? Results from a benchmark study in the New Aquitaine region.

BACKGROUND: A benchmark study was conducted in the southwest of France, in the New Aquitaine region, to investigate metabolic outcomes and availability of resources in pediatric diabetes units. We assessed whether the level of care was in accordance with the International Society for Pediatric and Adolescent Diabetes recommendations. METHODS: Demographic and clinical data were collected, as were all HbA1c tests for the 2017 calendar year. Pediatricians specialized in diabetes care were invited to complete an online survey concerning means allocated to the management of type 1 diabetes in their centers. RESULTS: Sixteen centers provided data for 1277 patients and 3873 clinical visits. A total of 1115 children suffering from diabetes for more than 1 year were studied. Median HbA1c was 8% (7.4-8.6) for the whole region. Only 29.2% of children had good metabolic control in accordance with the <7.5% target. We identified slight but significant variation in glycemic control among centers (P=0.029). The use of an insulin pump varied greatly among centers but did not explain HbA1c differences. We did not identify a correlation between medical or paramedical time dedicated to the follow-up of diabetic patients and the mean HbA1c of each center. For 100 diabetic patients, follow-up was provided by 0.42 physicians (0.23-1.50), 0.15 nurses (0-0.56), 0.12 dietitians (0-0.48), and 0.07 psychologists (0-0.30). CONCLUSION: This study demonstrates a lack of human resources allocated to the management of type 1 diabetes in the region that is far below international recommendations. The proportion of children achieving the international glycemic target is low. There is a clear need to improve glycemic control in children, which will only be possible with improved professional practices, encouraged by benchmark studies, and by increasing the size of our multidisciplinary teams.

[Why pediatric consultations increase in the centers for the socially excluded?]. / Pourquoi les consultations pédiatriques augmentent-elles dans les structures de soins pour exclus?

Studies done by Médecins du Monde indicate that sanitary exclusion is a growing phenomenon in France, children included. Paediatricians must be concerned by this phenomenon, which is related to the social precarity of many families who do not use the standard health care structure. They must understand the reasoning behind the choices of these families, and be involved in the care of their children in places that they accept to visit. Paediatricians should also be present in institutions, conferences and debates where public health policy is discussed in order to defend the place of paediatrics in the sanitary organisation.

[What is the choice of training in neonatal intensive care? Analysis of wishes from 106 neonatologists]. / Quels choix pédagogiques pour la formation à la réanimation du nouveau-né? Analyse des souhaits de 106 néonatologues.

BACKGROUND: Improvement of the care to the neonate relys on an increased number of pediatricians in nurseries and adequate neonatal resuscitation training. METHODS: A questionaire about the optimal modes of neonatal resuscitation training was sent to 132 pediatricians in charge of a neonatal unit or a neonatal intensive care unit. Response rate was 80.3%. RESULTS: The training program was targeted to be regional for the organization and for the evaluation. Nevertheless, 41% of answers also favored local evaluation. Duties in neonatal intensive care unit or transportation system, with differences among areas, were the proposed training choices. The pediatrician was considered to be the first person as an instructor and also as a learner in a multidisciplinary training program. Cooperation between primary and tertiary centers physicians was proposed as the best way for training. Proposed criteria for evaluating training efficacy included neonatal mortality and meconium aspiration syndrome rates. Government funding was suggested in 92% of answers. CONCLUSION: It seems necessary to perform a wide neonatal resuscitation training program. This multidisciplinary approach should be regional and follow the guidelines of the neonatal study group.