Le Floch J P, Thervet F, Desriac I, Boyer J F, Simon D
Clinique de Villecresnes, 94440 Villecresnes, France.
Diabetes Metab. 2000 Feb;26(1):43-9.
To describe the characteristics of diabetic patients, the associated risk factors, the complications of the disease and its management by general practitioners (GPs) in France, a randomised sample of French GPs was asked to record data on all consecutive diabetic patients attending a regular visit within 3 months. Data were obtained by interview, clinical examination and usual follow-up complementary examinations of the patients. Patients were classified into 3 groups:, patients treated with insulin and considered to have type 1 diabetes, [2i], insulin-treated patients expected to have type 2 diabetes, [2d], patients with type 2 diabetes and not treated with insulin. Data from 7540 diabetic out-patients were recorded by 3084 GPs: 657 patients (8.7%) belonged to group 1, 1383 patients (18.3%) to group 2i and 5351 (71.0%) to group 2d. Patients, including 53.7%, [2i] 54.1%, and [2d] 56.5% of men, were (mean +/- SE) 58.8 +/- 0.7, [2i] 63.4 +/- 0.3, and [2d] 63.9 +/- 0.2 years old, respectively. Duration of diabetes was 15.9 +/- 0.4, [2i] 11.4 +/- 0.2, and [2d] 10.1 +/- 0.1 yr. The last fasting blood glucose level (laboratory assay) was 1.61 +/- 0.02, [2i] 1.68 +/- 0.01, and [2d] 1.61 +/- 0.01 g/L, and the last HbA1c 8.5 +/- 0.1, [2i] 8.1 +/- 0.1, and [2d] 7.8 +/- 0.1%, respectively. Tobacco smoking was observed in 19.2%, [2i] 13.1%, and [2d] 12.6% of the patients, hypertension in 39.6%, [2i] 55.9%, and [2d] 58.6%, micro- or macro-albuminuria in 18.6%, [2i] 11. 2%, and [2d] 9.5%, retinopathy in 31.1%, [2i] 12.9%, and [2d] 8.6%, and history of coronary artery disease in 16.3%, [2i] 15.0%, and [2d] 12.8%. Self-monitoring of blood glucose was performed by 93.2%, [2i] 37.9%, and [2d] 16.9% of the patients. During the previous 12 months, a visit had been performed with a diabetologist in 54.0%, [2i] 20.7%, and [2d] 12.9% of the patients, with an ophthalmologist in 62.9%, [2i] 51.5%, and [2d] 49.4%. These results underline the specific characteristics of French diabetic patients. A high prevalence of uncontrolled risk factors, mainly hypertension, contrasts with a relatively low frequency of micro- and macro-angiopathy, maybe underestimated by non-systematic routine follow-up. Closer collaboration between GPs and specialists should be developed to improve the management and care of diabetic patients in France.
为描述法国糖尿病患者的特征、相关危险因素、疾病并发症及其由全科医生（GPs）进行的管理情况，选取了一个法国全科医生随机样本，要求他们记录在3个月内接受定期就诊的所有连续糖尿病患者的数据。通过对患者进行访谈、临床检查及常规随访补充检查来获取数据。患者被分为3组：接受胰岛素治疗且被认为患有1型糖尿病的患者，[2i]预计患有2型糖尿病的胰岛素治疗患者，[2d]患有2型糖尿病且未接受胰岛素治疗的患者。3084名全科医生记录了7540名糖尿病门诊患者的数据：657名患者（8.7%）属于第1组，1383名患者（18.3%）属于第2i组，5351名患者（71.0%）属于第2d组。患者中男性比例分别为53.7%、[2i]54.1%和[2d]56.5%，平均年龄（均值±标准误）分别为58.8±0.7岁、[2i]63.4±0.3岁和[2d]63.9±0.2岁。糖尿病病程分别为15.9±0.4年、[2i]11.4±0.2年和[2d]10.1±0.1年。上次空腹血糖水平（实验室检测）分别为1.61±0.02、[2i]1.68±0.01和[2d]1.61±0.01g/L，上次糖化血红蛋白水平分别为8.5±0.1%、[2i]8.1±0.1%和[2d]7.8±0.1%。患者中吸烟率分别为19.2%、[2i]13.1%和[2d]12.6%，高血压患病率分别为39.6%、[2i]55.9%和[2d]58.6%，微量或大量白蛋白尿患病率分别为18.6%、[2i]11.2%和[2d]9.5%，视网膜病变患病率分别为31.1%、[2i]12.9%和[2d]8.6%，冠心病病史患病率分别为16.3%、[2i]15.0%和[2d]12.8%。分别有93.2%、[2i]37.9%和[2d]16.9%的患者进行血糖自我监测。在过去12个月中，分别有54.0%、[2i]20.7%和[2d]12.9%的患者拜访过糖尿病专科医生，分别有62.9%、[2i]51.5%和[2d]49.4%的患者拜访过眼科医生。这些结果突显了法国糖尿病患者的特定特征。主要是高血压的未控制危险因素患病率较高，这与微血管和大血管病变相对较低的发生率形成对比，可能因非系统性常规随访而被低估。应加强全科医生与专科医生之间的密切合作，以改善法国糖尿病患者的管理和护理。
