URC Eco Ile-de-France (AP-HP), Hôtel Dieu - Galerie B1 - 3ème étage, 1 Place du Parvis Notre Dame, 75004 Paris, France.
Global Health. 2014 Feb 20;10:6. doi: 10.1186/1744-8603-10-6.
The objective of this review was to describe and situate the burden and treatment of diabetes within the broader context of the French health care system.
Literature review on the burden, treatment and outcomes of diabetes in France, complemented by personal communication with with diabetes experts in the Paris public hospital system.
Prevalence of diabetes in the French population is estimated at 6%. Diabetes has the highest prevalence among all chronic conditions covered 100% by France's statutory health insurance (SHI), and the number of covered patients has doubled in the past 10 years. In 2010, the SHI cost for pharmacologically-treated diabetes patients amounted to €17.7 billion, including an estimated €2.5 billion directly related to diabetes treatment and prevention and €4.2 billion for treatment of diabetes-related complications. In 2007, the average annual SHI cost was €6 930 for patients with type 1 diabetes and €4 890 for patients with type 2 diabetes. Complications are associated with significantly increased costs. Diabetes is a leading cause of adult blindness, amputation and dialysis in France, which also has one of the highest rates of end-stage renal disease in Europe. Cardiovascular disease is the leading cause of death among people with diabetes. Historically, the French health care system has been more oriented to curative acute care rather than preventive medicine and management of long-term chronic diseases. More recently, the government has focused on primary prevention as part of its national nutrition and health program, with the goal of reducing overweight and obesity in adults and children. It has also recognized the critical role of the patient in managing chronic diseases such as diabetes and has put into place a free patient support program called "sophia". Additional initiatives focus on therapeutic patient education (TPE) and the development of personalized patient pathways.
While France has been successful in protecting patients from the financial consequences of diabetes through its SHI coverage, improvements are necessary in the areas of prevention, monitoring and reducing the incidence of complications. Systemic changes must be made to improve the coordination and delivery of chronic care.
本综述旨在描述法国医疗体系中糖尿病的负担和治疗情况，并将其置于更广泛的背景下进行分析。
对法国糖尿病负担、治疗和结局相关文献进行综述，并与巴黎公立医院系统的糖尿病专家进行个人交流。
法国人群中糖尿病的患病率估计为 6%。在法国全民健康保险覆盖的所有慢性病中，糖尿病的患病率最高，且在过去 10 年中，参保人数翻了一番。2010 年，全民健康保险为接受药物治疗的糖尿病患者支付的费用达 177 亿欧元，其中估计有 25 亿欧元直接与糖尿病治疗和预防有关，42 亿欧元用于治疗糖尿病相关并发症。2007 年，1 型糖尿病患者的全民健康保险平均年费用为 6930 欧元，2 型糖尿病患者为 4890 欧元。并发症会导致费用显著增加。在法国，糖尿病是成年人失明、截肢和透析的主要原因，也是欧洲终末期肾病发病率最高的国家之一。心血管疾病是糖尿病患者死亡的主要原因。法国的医疗体系历史上更侧重于治疗急性疾病，而不是预防医学和管理长期慢性疾病。最近，政府将重点放在初级预防上，作为国家营养和健康计划的一部分，目标是减少成年人和儿童超重和肥胖。政府还认识到患者在管理糖尿病等慢性病方面的关键作用，并实施了名为“sophia”的免费患者支持计划。其他举措侧重于治疗性患者教育（TPE）和制定个性化患者路径。
尽管法国通过全民健康保险覆盖成功地保护了患者免受糖尿病带来的经济后果，但在预防、监测和减少并发症发生率方面仍需改进。必须进行系统性变革，以改善慢性病的协调和提供。
