Patients' education, and its impact on care outcomes, resource consumption and working conditions: data from the International Diabetes Management Practices Study (IDMPS).

AIM: To evaluate the impact of diabetes education provided to patients with type 2 diabetes mellitus (T2DM) in non-controlled studies ("real-world conditions") on quality of care, resource consumption and conditions of employment. METHODS: This cross-sectional study and longitudinal follow-up describe the data (demographic and socioeconomic profiles, clinical characteristics, treatment of hyperglycaemia and associated cardiovascular risk factors, resource consumption) collected during the second phase (2006) of the International Diabetes Management Practices Study (IDMPS). Patients received diabetes education directly from the practice nurse, dietitian or educator, or were referred to ad hoc group-education programmes; all programmes emphasized healthy lifestyle changes, self-care and active participation in disease control and treatment. Educated vs non-educated T2DM patients (n=5692 in each group), paired by age, gender and diabetes duration, were randomly recruited for the IDMPS by participating primary-care physicians from 27 countries in Eastern Europe, Asia, Latin America and Africa. Outcome measures included clinical (body weight, height, waist circumference, blood pressure, foot evaluation), metabolic (HbA(1c) levels, blood lipid profile) and biochemical control measures. Treatment goals were defined according to American Diabetes Association guidelines. RESULTS: T2DM patients' education significantly improved the percentage of patients achieving target values set by international guidelines. Educated patients increased their insulin use and self-care performance, had a lower rate of chronic complications and a modest increase in cost of care, and probably higher salaries and slightly better productivity. CONCLUSION: Diabetes education is an efficient tool for improving care outcomes without having a major impact on healthcare costs.

[The contribution of computerized tomography to the diagnosis of diffuse pulmonary lymphangiomyomatosis. Apropos of a case]. / Apport de la tomodensitométrie au diagnostic de lymphangiomyomatose pulmonaire diffuse. A propos d'un cas.

The authors report a case of lymphangiomatosis (LAM) proven histologically in a 49 year old female. This case benefitted from very detailed CT-scanning (IDM) with characteristic images obtained from the thorax and bilateral renal tumours suggestive of angiomyolipomas. This association seems to be quasi-pathognomic of the disease. The discovery at CT-scanning of cerebral calcification raises a possible connection of LAM with Bourneville's tuberous sclerosis. This CT-scanning study has several points of interest: the early diagnosis of pulmonary lesions which are under evaluated by standard radiography; a complete inventory of the possible localisations of the disease; it enables a possible diagnosis in very frail patients in whom a lung biopsy would be a risk; an ability to assess further progress as there also exists a good correlation between the extent of the disease assessed by TDM and the disturbance in pulmonary function.

[Plasmacytoma of the mediastinum. A new case]. / Plasmocytome du médiastin. Un nouveau cas.

We report the case of a 61-year old man in whom ablation of a hilar tumour enabled us to diagnose a mediastinal plasmacytoma. Plasmacytomas are rarely found in the mediastinum and sometimes evolve towards myelomas. The best treatment seems to be surgery combined with radiotherapy. The effectiveness of chemotherapy against this tumour is questionable.