m-Diabete in Senegal. "Be He@lthy Be Mobile", a program initiated by WHO and the ITU.

The health-care systems of Africa must adapt to the exponential progression of nontransmissible diseases, diabetes in particular. How can we accelerate population awareness of the risk factors? How can we provide the minimal education necessary to all people with diabetes to limit its complications? The "Be He@lthy Be Mobile" initiative of WHO and the ITU (International Telecommunications Union) and its "m-Diabete" app in Senegal explore the conditions for establishing a large-scale patient-education program using texting and its potential health impact.

WHO-5, a tool focusing on psychological needs in patients with diabetes: the French contribution to the DAWN study.

AIM: In 2001, the international Diabetes Attitudes, Wishes and Needs (DAWN) programme was launched to evaluate the psychosocial impact of diabetes. In France, DAWN experts carried out an observational study to further understand the impact of diabetes on the psychological well-being of people with diabetes, using the French version of the WHO-5 questionnaire. METHODS: The WHO-5, a unidimensional five-item questionnaire that measures positive psychological well-being, was completed by 2213 patients (1670 with diabetes). A total sum score was calculated, ranging on a scale from 0 to 25. A score less than 13 indicated impaired well-being and a score less than 8 reflected likely depression. RESULTS: The mean total well-being score for the whole study population was 14.1±5.5, and 14.3±5.5 for patients with diabetes and 13.5±5.4 for patients with other chronic diseases. The average score for patients with diabetes only (15.1±5.2) was higher than those for the other subgroups (P=0.005), whereas the average scores for those using insulin (14.8±5.2) and women with diabetes (13.2±5.6) were significantly lower compared with the whole diabetic group (15.6±5.1 [P=0.03] and 15±5.2 [P<0.001], respectively). CONCLUSION: The WHO-5 questionnaire showed satisfactory psychometric properties in a large sample of French diabetic patients. The scale is unidimensional and highlighted differences in well-being, which was lower in diabetic women, in patients with other chronic diseases and in those treated with insulin.

European Union diabetes indicators: fact or fiction?

Diabetes mellitus is one of the major causes of morbidity and mortality in EU/EFTA countries. Monitoring risk factors for diabetes and its complications will offer the possibility to evaluate the development in time as well as the influence of possible interventions. In this investigation a list with core and secondary indicators is proposed. Availability of these indicators and their data sources is discussed. An important variability of data sources is used in EU/EFTA countries, interfering with the comparability of the outcome. Further harmonisation as well as continuous evaluation of data sources will be necessary to provide reliable tools to monitor diabetes mellitus and its outcome on a routine basis.

Effects of clinical audit on the quality of care in patients with type 2 diabetes: results of the DIABEST pilot study.

OBJECTIVE: To improve the quality of diabetes care in general practice by the use of audit. MATERIAL AND METHODS: A prospective multicenter pilot study. Thirty-five groups of ten general practitioners (GPs) have been set up throughout France on a voluntary basis. These groups were led by a steering committee that includes a diabetologist and a GP. Each group established a consensus on healthcare standards and carried out 2 data collections over a 12-month period, with adoption of corrective measures between these 2 collections. RESULTS: 309 (90.4%) of the 342 practitioners completed the first data collection, assessing the management of 3,125 patients over a year. Less than half the groups have reached the 80% reference threshold for quality of care with regard to foot examination, microalbuminuria, ECG, fundoscopy and assessment of diet. The audit also found no intervention within one year in case of poor glucose control for 47% of patients, unsatisfactory quality of HbA(1c) measurement and insufficient resources for diet and education. 226 (66.1%) practitioners completed the second data collection assessing the management of 2,248 patients. Comparison between the two phases of the audit showed significant improvements for all the indicators of the process of care (p<0.001). Quality of HbA(1c) measurement and diet assessment by GPs progressed (p<0.01). Outcomes of care also improved with respect to the proportion of patients with HbA(1c)<=8% (p=0.007), fasting glycaemia<1.40 g/l (p=0.05) and SBP<140 mmHg (p=0.02). CONCLUSIONS: This pilot study confirms the feasibility of using clinical audit at the national level. It seems to be an effective measure to improve the management of patients with type 2 diabetes in primary care. It is intended that the large-scale DIABEST study will address this issue.

QUALIDIAB: implementation of the Diabcare project in the French-speaking environment: regional, national and international issues. Qualidiab Group.

Diabcare is an international Project devoted to the evaluation of the Quality of Care [1] in the population of diabetic patients. As Diabetes is one of the most frequent chronic illnesses, the management of its treatment has a strong impact on the public health policy both regional and national [2]. Funded by the European Commission, initiated by WHO and the International Diabetes Federation (IDF), this Project is now recognised as a Pilot Project throughout the world as an example of a large international collaboration for the surveillance of quality of care in a typical chronic disease.

[Five years of DiabCare--France: assessment and outlook]. / Les cinq ans de DiabCare--France: bilan et perspectives.

The Declaration of Saint Vincent was the starting point for the European DiabCare system. Five years of French experience with this system now provide an opportunity for critical assessment. Within the perspective of quality assurance, DiabCare is an efficient developmental tool which should eventually allow the divergence between real and ideal quality to be reduced. On the basis of a European scientific reference system, each country uses its own funds to organise national campaigns with the assistance of pharmaceutical firms. Each year a transverse collection of a month's data concerning all hospitalised diabetic patients is done at the European level by means of a standardised form. Confidential and anonymous analysis of the data is then performed by the scientific committee of DiabCare-France and the CERIM of Lille. Each participating physician receives a report specifying the situation for his group and providing anonymous comparisons with national data. This rich database offers each centre the possibility for "personalised" appraisal and retrospective evaluation of modifications in medical practices. DiabCare is in fact of interest to a variety of persons and organisations. For the patient, the DiabCare sheet and the forthcoming Diabcard (smart card) are means of providing guidance for the annual checkup. The general practitioner or specialist has indications about his patients' condition and guidance for more rigorous management. Interestingly, DiabCare is the only evaluation programme approved by general practitioner unions. For the hospital department, DiabCare provides much more detailed information than PMSI, offering a department head useful arguments in support of specific budget allocations and allowing the care team to consider its activity and determine priorities. It is a useful and precise evaluation tool for hospitals in the perspective of future accreditation. For the national and international scientific community, it provides data which, though biased by voluntary participation and non-epidemiological, are useful for analysis and comparison of particular diabetological circumstances in the field. In this respect, it is noteworthy that the World Health Organisation (WHO), the International Diabetes Federation, and the CSD have supported this initiative. For WHO, care practices and payment systems differ considerably in European countries, so that the existence of a common tool for collecting and evaluating data allows relevant procedures to be identified more quickly and communicated and recommended to the different governments. Finally, in view of the human and economic burden caused by late complications of diabetes, society can benefit. Any improvement in the control of risk factors and the objective reduction of complications is important for survival of the health care system.