Diabetes incidence in subjects with PREDIABetes from ReUNion Island: the PREDIABRUN observational cohort study protocol.

INTRODUCTION: Improved knowledge of prediabetic subjects' profile and their risk of developing type 2 diabetes mellitus (T2DM) would enhance secondary prevention. The primary objective is to describe factors associated with incident T2DM in subjects with pre-diabetes diagnosed in primary care. METHODS AND ANALYSIS: The study is based on Reunion Island, a French overseas region that experiences a particularly high disease burden of T2DM. This is an observational, non-randomised prospective cohort study conducted in primary care in which private general practitioner (GP) investigators recruit participants with pre-diabetes from their practices regardless of the initial motive for consultation. Pre-diabetes is defined by WHO criteria, that is, fasting plasma glucose between 1.10 g/L and 1.25 g/L and/or plasma glucose 2 hours after ingestion of 75 g of glucose (2-hour post load plasma glucose) between 1.40 g/L and 1.99 g/L. The design is based on an annual follow-up by the GP (according to French National Health Authority recommendations) with collection of clinical and laboratory data and specific lifestyle questionnaires answered by telephone at three time points: inclusion, and at 2-year and 5-year follow-up visits. Follow-up clinical and laboratory data are collected by the investigating GP as part of the study, and study-specific laboratory collections (serum, DNA and urine) will be obtained 2 and 5 years after inclusion. The primary outcome is transition to T2DM. ETHICS AND DISSEMINATION: This protocol has been approved by the research ethics committee of Saint Etienne (CPP Saint Etienne reference number: 2019-03). Enrolment began in August 2019. Results will be disseminated in at least three papers published in peer-reviewed medical journals, one oral communication and a large-scale communication to the local population and healthcare policymakers. TRIAL REGISTRATION NUMBER: NCT04463160 and ID-RCB 2018-A03106-49.

Scabies incidence and association with skin and soft tissue infection in Loyalty Islands Province, New Caledonia: A 15-year retrospective observational study using electronic health records.

BACKGROUND: Scabies and its complications are a public health problem in the low- and middle-income countries of the Western Pacific region. However, no data are available for the relatively wealthy French territory of New Caledonia. This study aimed to determine the incidence of scabies and its association with skin and soft tissue infection (SSTI) in Loyalty Islands Province (LIP) (20,000 inhabitants), New Caledonia. METHODOLOGY/PRINCIPAL FINDINGS: This retrospective observational study reviewed cases of scabies and SSTI extracted from the electronic health record databases of LIP clinics for the period 2004-2018. Data were validated through double sampling. The overall scabies incidence rate (IR) and scabies IRs by sex and age group were calculated. Scabies seasonality was evaluated. For children <5 years, the presence of SSTI was compared between the 3-month period preceding scabies diagnosis/treatment and the 3-month period preceding the 1-year anniversary of scabies diagnosis/treatment (self-matching). A total of 16,843 scabies cases were extracted using a detection algorithm with a sensitivity of 96.7% and a specificity of 99.9%. From 2004 to 2018, the average overall scabies IR was 5.9% and the average scabies IR in children <1 year was 18.4%. Almost two-thirds of children aged 14 years had a history of scabies. Females were more affected, especially in the 20-39 age group (sex ratio>2). A strong seasonality was observed, with a 30% increase in winter. In children <5 years, SSTIs were 4.3 times more frequent in the 3 months preceding the scabies diagnosis than in the 3 months preceding the 1-year anniversary of scabies treatment (p<0.001). CONCLUSIONS: Although health care is much better in New Caledonia than in neighboring countries, scabies is highly endemic in LIP. The disease is especially common in children <2 years and is associated with many SSTIs in children <5 years. Mass drug administration should be considered.

[Impact of peer visits]. / Impact des "visites de pairs". Etude randomisée à l'île de la Réunion sur l'amélioration du suivi des patients diabétiques.

OBJECTIVES: To measure the impact of an intervention on the general practitioners (GP) of Reunion in order to improve the management of patients with type 2 diabetes, in conforming with the recommendations of the Anaes. METHOD: Randomised intervention study on a random sample of 120 practitioners out of a total of 630 GP in Reunion, 60 in the intervention group (IG) and 60 in the control group (CG). Each doctor of the IG received 2 visits by a "visiting GP" which have had specific training. The period of observation included the 12 months before, and the 6 months after the date of the intervention. Data were collected retrospectively, at the end of 18 months of observation; in medical records of 25 diabetics seen consecutively in consultation, the GP collected the dates of performance of six procedures under surveillance: HbA1c, examination of the feet, fundoscopy, ECG, estimation of the creatinine clearance, level of micro-albuminuria. Outcome measures were delays in performance of the procedures conforming to the recommendations. RESULTS: 42 GP out of 60 in the IG, and 40 out of 60 in the CG participated to the study. Patients included, 792 in the IG and 789 in the CG, were comparable for age, sex-ratio and profession. The distribution of delays in performance before the intervention was comparable in the two groups. The comparison between the groups after the intervention showed a significantly important improvement in the IG for 4 to 6 of the procedures: examination of the feet, fundoscopy, creatinine clearance and micro-albuminuria. CONCLUSION: In the short-term, a "outreach visit" or "academic detailing" improves the delay in performance of most of the surveillance procedures in type 2 diabetes.