[Development of the medical treatment of diabetes in Luxembourg]. / Evolution du traitement médicamenteux du diabète au Luxembourg.

OBJECTIVES: The aims of the study were to estimate the prevalence of diabetes in Luxembourg in 2002, to compare it to the prevalence reported in 1991 and to evaluate if prescription attitudes have changed since 1991. METHODS: The prevalence of diabetes was estimated using the drug sales data. The key parameters, total amount of antidiabetic drugs sold in one year and the average daily dose or Prescribed Daily Dose (PDD), have been obtained from the National Social Security Organization and by a standardized questionnaire sent to all general practitioners and all internists and endocrinologists of the country. RESULTS: The PDD was calculated on 2,402 questionnaires on individual diabetic patients. By this mean, the proportion of patients only treated with appropriate diet could also be obtained. Compared to 1991, the total amount of antidiabetic drugs showed a four-fold increase in biguanides tablet prescriptions. A high percentage of combined treatments was found. The prevalence of diabetes in Luxembourg was found to be 3.05% of the total population. CONCLUSIONS: Compared to the status in 1991, prevalence of diabetes increased by 63%, which seems mainly due to type 2 diabetic patients as orally-treated diabetic patients almost doubled (2.11% vs 1.16%). A substantial change in prescriptions for diabetes has occurred, suggesting a positive influence of studies like the United Kingdom Prospective Diabetes Study (UKPDS).

Changes in diabetes prevalence and treatment in the last ten years in Luxembourg. A lesson from the United Kingdom prospective diabetes study?

OBJECTIVES: The aims of the study were to estimate the prevalence of diabetes in Luxembourg in 2002, to compare it to the prevalence reported in 1991 and to evaluate if prescription attitudes have changed since 1991. METHODS: The prevalence of diabetes was estimated using the drug sales data. The key parameters, total amount of antidiabetic drugs sold in one year and the average daily dose or Prescribed Daily Dose (PDD), have been obtained from the National Social Security Organization and by a standardized questionnaire sent to all general practitioners and all internists and endocrinologists of the country. RESULTS: The PDD was calculated on 2, 402 questionnaires on individual diabetic patients. By this means, the proportion of patients only treated with appropriate diet could also be obtained. Compared to 1991, the total amount of antidiabetic drugs showed a four-fold increase in metformine tablet prescriptions. A high percentage of combined treatments was found. The prevalence of diabetes in Luxembourg was found to be 3.05% of the total population. CONCLUSIONS: Compared to the status in 1991, prevalence of diabetes increased by 63%, which seems mainly due to type 2 diabetic patients as orally-treated diabetic patients almost doubled (2.11% vs 1.16%). A substantial change in prescriptions for diabetes has occurred, suggesting a positive influence of studies like the United Kingdom Prospective Diabetes Study (UKPDS).

[Lipiwatch: a study of the treatment of dyslipidemias in Luxembourg]. / Lipiwatch: une étude du traitement des dyslipidémies au Luxembourg.

LIPIWATCH is an observational study which has been initiated for 6 months in Belgium and in Luxembourg in 1997 to evaluate if patients treated by lipid-lowering drugs could reach the recommendations of the EAS and NCEP II for LDL-C. 76 patients (31 men) with a mean age of 59.2 +/- 11.39 years were included. 96% of patients had at least one other associated cardiovascular risk factor. After 6 months of treatment, 33% of all patients and only 30% of patients with coronary heart disease or peripheral vascular disease or at least 2 other risk factors reached the recommendations of the EAS. 25% of all patients and only 20% of patients with known coronary heart disease reached the NCEP II recommendations. 55% of patients had a statin prescribed and 38% a fibrate. Mean total cholesterol and mean LDL-C was lowered by 20% and 19% after 6 months. These disappointing results confirmed an insufficient awareness by physicians and patients, inadequate dosages of drugs and a bad compliance by patients.

[Prolonged treatment of sugar diabetes by subcutaneous insulin infusion using a peristaltic pump and an insulin solution concentrated to 100 Iu/ml]. / Traitement prolongé du diabète sucré par perfusion sous-cutanée d'insuline intérêt d'une pompe péristaltique et d'une solution insulinique concentrée a 100 uI/ml.

The authors have treated 6 diabetic patients for at least 3 months with subcutaneous insulin infusion system using a peristaltic pump and a highly stable preparation (U 100 with physiological pH). Correct diabetic control was achieved in each case, during a cumulative period of 44 patients-months. The high stability of the insulin preparation allows a prolonged insulin storage in the pump, from 2 to 3 months without any change in the hypoglycaemic effect of the solution. Advantages and risks of this method are discussed.

[Insulin-dependent diabetes with acute onset. Remissions induced by early temporary blood glucose normalization]. / Diabètes insulino-dépendants de début aigu. Rémissions induites par normalisation glycémique transitoire précoce.

Within 6 months of the acute onset of an insulin-dependent diabetes, remission of insulin-dependence was attempted in 30 hospital patients by strict control of glycaemia obtained in a few days with intravenous infusions of insulin, using a macropump. This was followed by an oral antidiabetic treatment, and the patients were considered in remission when metabolic control was achieved. By this method remission of insulin-dependence was obtained in 90% of the patients; it lasted for more than 1 year on average, and its degree seemed to depend on the time elapsed between the clinical onset of the disease and the beginning of the intravenous treatment but also, to a lesser extent, on the residual secretory capacity of the pancreas when this treatment was instituted. Thus, an intensive metabolic control increases the effectiveness of an oral treatment as regards both number of patients improved and duration of remission. When administered alone at the onset of the disease the oral treatment is only effective in about 30% of the cases.

[Acquired remissions of insulin dependence in recent diabetes mellitus. Essential prognostic factors]. / Rémissions acquises de l'insulino-dépendance de diabètes récents. Facteurs pronostiques essentiels.

24 patients with recent diabetes mellitus (less than three years) were given an intravenous insulin infusion over a short period (84 to 252 hours) in an attempt to achieve a remission of their disease through rigorous normalization of blood glucose concentrations. After this treatment, strict control of diabetes mellitus was achieved with oral mediactions in 15 of the 24 patients. In 17 cases, onset of diabetes mellitus had been sudden and insulin was required immediately (acute cetosic diabetes: ACD); in 7 patients, signs of insulin deficiency had occurred only after seven months of hyperglycemia (secondary insulin-dependent diabetes mellitus: SIDDM). A strong probability of achieving an insulin-induced remission exists only during the first six months of ACD. The success of the insulin infusion is partly dependent upon the residual beta cell function. During the remission, which lasts for more than 12 months in 50% of cases, control of diabetes mellitus is optimal.