Department of General Medicine, Cayenne Hospital Center, Cayenne, French Guiana.
Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424) Cayenne Hospital Center, Cayenne, French Guiana.
Front Endocrinol (Lausanne). 2022 Jul 22;13:937156. doi: 10.3389/fendo.2022.937156. eCollection 2022.
The social parameters of an individual impact the incidence of cardiovascular diseases. French Guiana, an overseas French territory with a lower standard of living than France, has a prevalence of diabetes mellitus that is twice that of mainland France. In this context we aimed to study the relation between precariousness, diabetes complications and glycemic control.
A multicenter prospective cohort was initiated since May 2019. 1243 patients were included and their outcomes and history were compared between the precarious and non-precarious based on their EPICES score, a score that measures social isolation and precariousness.
73.3% of the sample was considered precarious. Retinopathy was significantly more frequent among the deprived. There were no significant differences for other macro or microvascular complications.There was a significant difference in Glycated Haemoglobin between the precarious and non-precarious groups (8.3% (67 mmol/l) vs 8.8% (73mmol/l)). After adjusting for potential confounders, precariousness was no longer associated with poor glycemic control; the independent factors significantly associated with poor glycemic control were: not being fluent in French, having creole or portugese as mother language, and not having any insurance.
Precariousness is a risk factor for retinal complications in patients with diabetes mellitus in French Guiana. In this chronic disease, the universal healthcare system alleviates health inequalities for many, but not all, diabetic complications.Translation and cultural mediation may further reduce health inequalities in this multicultural territory where a substantial proportion of the population is not fluent in French.
个体的社会参数会影响心血管疾病的发病率。法属圭亚那是法国的一个海外属地，生活水平低于法国，其糖尿病患病率是法国本土的两倍。在这种情况下，我们旨在研究不稳定性与糖尿病并发症和血糖控制之间的关系。
自 2019 年 5 月以来，我们启动了一项多中心前瞻性队列研究。共纳入 1243 例患者，根据 EPICES 评分（一种衡量社会隔离和不稳定性的评分）将患者分为不稳定和非不稳定两组，比较两组患者的结局和病史。
样本中 73.3%的患者被认为不稳定。在贫困组中，视网膜病变更为常见。其他大血管或微血管并发症无显著差异。不稳定组与非不稳定组的糖化血红蛋白（HbA1c）水平存在显著差异（8.3%（67mmol/l）比 8.8%（73mmol/l））。调整潜在混杂因素后，不稳定与血糖控制不佳不再相关；与血糖控制不佳显著相关的独立因素为：法语不流利、母语为克里奥尔语或葡萄牙语、无任何保险。
在法属圭亚那的糖尿病患者中，不稳定是视网膜并发症的一个危险因素。在这种慢性病中，全民医疗保健系统缓解了许多人的健康不平等，但并非所有糖尿病并发症都得到缓解。在这个多元文化的地区，翻译和文化调解可能会进一步减少卫生不平等，因为该地区相当一部分人口法语不流利。
