Diabetes education of patients and their entourage: out-of-hospital national study (EDUCATED 2).

AIMS: To determine the contributing factors in the successful diabetes education of patients and their entourage. METHODS: Prospective observational study conducted in a pre-hospital setting by 17 emergency services across France (September 2009-January 2011) included all insulin-treated patients (≥18 years) provided that at least one family member was present on scene. Data were collected from patients and their entourage: (1) personal details including language proficiency and educational attainment, (2) treatments, (3) diabetes-related data (log sheets, glucose meter, glucagon, glycated hemoglobin, prior hypoglycemic episodes); (4) care by diabetologist, general practitioner and/or visiting nurse. The main end points were ability to measure capillary blood sugar (patient) and awareness of hypoglycemia symptoms and ability to administer glucagon (entourage). RESULTS: Overall, 561 patients and 736 family members were included; 343 patients (61%) were experiencing a hypoglycemic episode (<2.5 mmol/L). A total of 141 (75%) patients and 343 (50%) family members could measure capillary blood sugar. They could name a median of 2 [0-3‰] hypoglycemia symptoms although 217 (39%) patients and 262 (39%) family members could name no symptom. Few patients (33%) had glucagon available. In multivariate analyses, the main factor associated with better patient education was care by a diabetologist. Lack of an educational qualification and visits by a nurse were associated with poor patient education, and French mother tongue and care by a diabetologist with better education of the entourage. CONCLUSIONS: In France, diabetic patients and their entourage are inadequately educated. Their education benefits most from care by a diabetologist.

[Prehospital noninvasive ventilation. Study of importance and feasibility (7 cases)]. / Ventilation non invasive en préhospitalier. Etude d'intérêt et de faisabilité (7 cas).

INTRODUCTION: Non-invasive ventilation can make it possible to avoid endotracheal intubation in patients with acute respiratory failure. Its use in mobile intensive care unit requires assessment of its feasibility. OBJECTIVES: To evaluate the feasibility of noninvasive ventilation in mobile intensive care unit among patients presenting an acute respiratory failure of varied causes. To evaluate the specific problems and to propose adapted answers. METHODS: Seven patients presenting with acute respiratory failure were included in a prospective study conducted with the SAMU (mobile intensive care unit) in Bordeaux between July 01 and November 01, 2000. Non-invasive ventilation was applied, in the absence of contraindications, using a standard facial mask to help inspiration and with added positive expiration pressure. Efficacy was assessed on clinical and biological criteria. RESULTS: Non-invasive ventilation improved the respiratory state in most patients and avoided endotracheal intubation in 6 patients. DISCUSSION: This study made it possible to advance criteria that we feel are essential with the implementation of this method of respiratory assistance, and provided solutions to the various problems encountered (equipment, training, protocols and follow-up of patients). CONCLUSION: Despite the limits of our study we were able to demonstrate the feasibility of non-invasive ventilation in prehospital setting. Future studies should be conducted on larger cohorts in order to specify the interest of non-invasive ventilation in such conditions.