The Burden of Diabetes in Haiti (French) Symposia, presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Care of Diabetic Patients in a Hospital Setting (French) Symposia, presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Diabetes and the Eye (French) Symposia, presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Care of Diabetic Patients in a Hospital Setting Symposia, presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Base ECG et l'interprétation du rythme (French) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Care of Diabetic Patients in a Hospital Setting (French) Symposia, presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Diabetes and the Eye (French) Symposia, presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Care of Diabetic Patients in a Hospital Setting Symposia, presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Base ECG et l'interprétation du rythme (French) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Basic EKG and Rhythm Interpretation Symposia presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Malaria in Haiti Symposia, presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Tetanus in Haiti Symposia, presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Basic EKG and Rhythm Interpretation Symposia - The CRUDEM FoundationThe CRUDEM Foundation
Basic EKG and Rhythm Interpretation Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Desde 2002, Tdh asegura un seguimiento a cerca de 1.000 jóvenes empleadas domésticas, originarias de la provincia de Sourou, en las grandes ciudades de Ouagadougou y Bobo-Dioulasso.
Basic EKG and Rhythm Interpretation Symposia presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Malaria in Haiti Symposia, presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Tetanus in Haiti Symposia, presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Basic EKG and Rhythm Interpretation Symposia - The CRUDEM FoundationThe CRUDEM Foundation
Basic EKG and Rhythm Interpretation Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Desde 2002, Tdh asegura un seguimiento a cerca de 1.000 jóvenes empleadas domésticas, originarias de la provincia de Sourou, en las grandes ciudades de Ouagadougou y Bobo-Dioulasso.
An overview of what s new in the impact of diabetes on the kidneys, be it physiopathological, epidemiological, clinical or therapeutic. A arge part is given to antiSLT2
Diabetes in Pregnancy (French) Symposia - The CRUDEM FoundationThe CRUDEM Foundation
Diabetes in Pregnancy Symposia (French) presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Similaire à The Burden of Diabetes in Haiti (French) - The CRUDEM Foundation (20)
Care of the Patient with Diabetes in Haiti (French) Symposia, presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Outpatient Diabetes Education - Haiti presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Outpatient Diabetes Education (French) - Haiti presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Nutrition Presentation - Diabetes Symposium - Haiti presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Nutrition Presentation - Diabetes Symposium - Haiti (French) presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Neuropathy and Foot Exam - Diabetes Symposia presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Neuropathy and Foot Exam - Diabetes Symposia (French) presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Care of the Patient with Diabetes in Haiti Symposia - The CRUDEM FoundationThe CRUDEM Foundation
Care of the Patient with Diabetes in Haiti Symposia, presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Heart Failure in Haiti (French) Symposia - The CRUDEM FoundationThe CRUDEM Foundation
Heart Failure in Haiti (French) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Diabetic Complications in Haiti Symposia presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Diabetic Crises in Haiti Symposia presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Pediatric Diabetes Symposia presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Medications To Treat Tuberculosis Symposia - The CRUDEM FoundationThe CRUDEM Foundation
Medications To Treat Tuberculosis Symposia presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Tuberculosis Treatment (French) Symposia - The CRUDEM FoundationThe CRUDEM Foundation
Tuberculosis Treatment (French) Symposia - The CRUDEM Foundation presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Tuberculosis Treatment Symposia - The CRUDEM Foundation presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Les médicaments pour traiter la tuberculose (French) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Infection Control and Antibiotic Stewardship Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Les Agents Antiretroviraux et Les Toxicites Associes avec Eux (French) Symposia The CRUDEM Foundation
Les Agents Antiretroviraux et Les Toxicites Associes avec Eux (French) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur. CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
HYPERTENSION ARTERIELLE: EVALUATION ET PRISE EN CHARGE Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Heart Failure in Haiti (French) Symposia - The CRUDEM FoundationThe CRUDEM Foundation
Heart Failure in Haiti (French) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Joignez-vous aux lauréates 2024 des Bourses d’application des connaissances pour étudiants du Centre de collaboration nationale en santé publique (CCNMO) afin de prendre directement connaissance de leurs travaux essentiels permettant de combler l’écart entre la recherche et la pratique. Ces étudiantes et ces nouvelles diplômées dirigent des stratégies d’application des connaissances novatrices. Cette séance souligne leur excellence scolaire et met de l’avant des stratégies uniques et transférables pour s’attaquer aux priorités actuelles en matière de santé publique.
Hannah Bayne, Université de l’Alberta – Supporting tomorrow’s stewards: A knowledge mobilization project for climate-health literacy in Alberta elementary schools [Soutenir les intendants et intendantes de demain : un projet de mobilisation des connaissances en faveur de la littératie climat-santé dans les écoles primaires de l’Alberta]
Miranda Field, Université de Regina – Decolonized theory of place [La théorie du lieu décolonisée]
Jordan Chin, Université McMaster – The art of creation: An arts-based knowledge translation method to promote and advocate for a healthy start to life [L’art de la création : une méthode d’application des connaissances fondée sur les arts pour promouvoir et défendre un bon départ en santé]
12. Défini6on
du
Diabète
• Le
diabète
est
une
affec6on
métabolique
caracterisée
par
la
présence
d’une
hyperglycémie
chronique
résultant:
– d’une
déficience
de
sécré6on
d’insuline,
–
d’anomalies
de
l’ac6on
de
l’insuline
sur
les
6ssus
cibles,
– ou
de
l’associa6on
des
deux.
13. Défini6on
du
diabète
Hyperglycémie
chronique
associée
à
des
dommages
à
long
terme
aux:
• Yeux
• Reins
• Nerfs
• Coeur
et
vaisseaux
sanguins
14. Particularités du diabète
• Maladie chronique
• Maladie complexe (physiopatho.,prise en
charge, traitement…)
• Atteint plusieurs systèmes
• La prévention et le traitement des
complications à long terme constituent une
majeure partie des soins à offrir
15. Etablir le Diagnostic du diabète
Normal Glycémie à Jeun Intolerance Diabète
marginale au glucose
Glycémie <110mg/dl 110 to 126mg/
à jeun dl
≥126mg/dl
2hr Post- <126mg/dl
Prandial
126 to ≥200mg/dl
200mg/dl
CDA
2003,
ADA
2004,
WHO
2002
16. L’épidémie
mondiale
du
diabète
• 285
millions
affectés
en
2010
• 438
millions
dans
2030
• L’augmenta6on
du
nombre
de
nouveaux
diabé6ques
est
encore
plus
évidente
dans
les
pays
en
voie
de
developpement
• En
Hai6:
300.000
diabe6ques
IDF
Diabetes
Atlas
17.
18.
19. Facteurs
de
Risque
pour
le
diabète
de
type
2
• Age
>
ou
=
40
ans
• Hérédité:
parent
1er
degré
• Popula6on
à
haut
risque/
Mode
de
vie
• Maladies
CV
(Hypertension,
Dyslipidémie...)
• Obésité
Abdominale/surpoids
• Histoire
d’Intolérence
au
glucose
• Histoire
de
grossesse
gesta6onelle
ou
de
macrosomie
• Ovaires
Polykys6ques
• Acanthosis
nigricans
• Schizophrénie
Slides
current
un6l
2008
21. Procédure
• Consentement
• Ques6onnaire
• Prise
des
mesures
anthropométriques:
– Poids,
hauteur,
tour
de
taille,
tour
de
hanche
• Contrôle
de
la
tension
artérielle
à
2
reprises
à
cinq
minutes
d’intervalle
• Contrôle
de
la
glycémie
et
référence
pour
HGPO
si
nécessaire
22. Prévalence du diabète et des
troubles de la tolérance au glucose
(Aire metropolitaine 2003)
Condition Prévalence (%) IC 95%
Diabète 7.30 ( 5.99- 8.61)
Intolérance au 5.41 ( 4.02- 6.80)
glucose
Hyperglycémie à jeun 2.78 ( 1.74- 3.82)
anormale
Troubles de la 15.49 (13.61-17.36)
tolérance au glucose
23.
24. Table 2. Prevalence (%) of glucose intolerance by age group
Age groups DM IGT IFG Pre-DM Total
(years)
20-39
Men 1.5 0.8 3.0 3.8 5.3
Women 2.1 3.8 1.3 5.1 7.2
40-64
Men 10.6 7.1 2.7 9.8 20.4
Women 14.4 6.0 3.7 9.7 24.1
65 +
Men 9.4 15.3 0.0 15.3 24.7
Women 22.7 12.6 3.2 15.8 38.5
All
Men 4.8 3.7 2.7 6.4 11.2
Women 8.9 5.6 2.4 8.0 16.9
25. Prévalence du diabète selon les
antécédents familiaux de diabète
Parents Prévalence (%) IC 95%
diabétiques
Oui 11.56 (6.72-16.40)
Non 6.80 (5.42- 8.17)
OR=1.79 (1.06-3.04)
26. Risque
de
diabete
selon
histoire
familiale
Type1 Type 1 Type 2 Type 2
Parent Risque Parent Risque
Mere 1 a 5% Mere 5 a 20%
Pere 5 a 15% Pere 5 a 20%
2 parents 0 a 25% 2 parents 25 a 50%
Frere/Soeur 5 a 10% Frere/Soeur 25 a 50%
Jumeaux 25 a 50% Jumeaux 60 a 75%
identiques identiques
27. Classifica6on
de
l’obésité
en
fonc6on
de
l’indice
de
masse
corporelle
(IMC)
Classe IMC (kg/m2) Risque
Maigreur < 18.5 Nul
Normale 18.5-24.9 Très faible
Surpoids 25.0-29.9 Léger
Obésité ≥ 30.0 Nettement augmenté
Classe I 30.0-34.9 Obésité modérée ou
commune
Classe II 35.0-39.9 Obésité sévère
Classe III ≥ 40.0 Obésité massive ou
morbide
28. Prévalence du diabète selon l’indice
de masse corporelle (IMC)
Obésité Prévalence IC 95%
IMC≥25.0 12.19 (9.64-14.74)
IMC<25.0 3.70 (2.50- 4.91)
OR: 3.61 (2.38-5.48)
29. Obésité et Rapport Taille/
Hanche
Obésité Rapport Taille/Hanche
Homme Femme
Androide ≥ 0.9 ≥ 0.85
Gynoide < 0.9 < 0.85
31. Obésité Abdominale et Tour de Taille
(ATP III)
Tour de Taille
Risque Homme Femme
Elevé ≥ 102cm (40”) ≥ 88cm (35”)
Modéré ou < 102cm (40”) < 88cm (35”)
faible
IDF
2006:
Homme:
≥
94cm
Femmes:
≥
80cm
32. Prévalence du diabète selon le type
d’obésité (Rapport Taille-Hanche)
Type d’obésité Prévalence (%) IC 95%
Androide 18.2 (15.2-21.8)
Gynoide 3.1 ( 1.9- 5.1)
OR=6.87 (3.95-12.11)
33. Prévalence du diabète selon le
type d’obésité (Tour de taille)
Obésité Prévalence (%) IC 95%
abdominale
Oui 15.60 (12.50-18.70)
Non 3.84 ( 2.68- 5.00)
OR=4.63 (3.20-6.69)
34. Pourcentage de sujets se sachant
malades au moment de l’interview
Condition Pourcentage de sujets
se sachant malades
Diabète 70.6
Hypertension 46.5
35. Les
10
premières
causes
de
mortalité
en
Hai6
-‐
1999
1. SIDA
2. Diarrhé
et
Gastroentérite
d’origine
infec6euse
3. Maladies
Cérébrovasculaire
4. Grippe
et
pneumopathie
5. Autres
formes
de
cardiopathie
6. Tuberculose
7. Grossesse,
accouchement,
puerpéralité
8. Malnutri6on
9. Infec6ons
spécifiques
de
la
période
néonatale
10. Diabète
sucré
Source:
Cer*ficat
de
décès
36. Dix
premieres
causes
de
mortalité
chez
les
personnes
agées
de
50
ans
et
plus
Hai9,
1997-‐1998
Analyse
des
Causes
de
Décès.
1997-‐1998
MSPP-‐OPS/OMS
37. Epidémiologie
des
complica6ons
chroniques
• Mortalité:
– Taux
2
à
10
fois
plus
important
et
d’autant
plus
élevé
que
le
DM
est
précoce.
– Dx
du
DM
après
30-‐35
ans,
risque
principal:
macroangiopathie,
surtout
coronaire
(2
sexes)
– Dx
plus
précoce,
risque
principal:
conséquences
de
la
néphropathie
(25
à
60%
après
15
à
30
ans
d’évolu6on
de
DM)
– Pronos6c
vital
assombri
par
présence
d’une
neuropathie
autonome
38. Épidémiologie
(suite)
• Morbidité:
– Macroangiopathie
• 2
à
4
fois
plus
fréquent
chez
les
DM
des
2
sexes
• 40
à
50%
après
25
ans
d’évolu6on
• Manifesta6ons
coronaires:
moi6é
des
cas
• Gangrène
et/ou
amputa6on:
12
à
19%
DM
de
plus
de
20
ans
– Néphropathie:
prévalence
diminue
après
30-‐40
ans
d’évolu6on
39. Épidémiologie
(suite)
• Morbidité
(suite)
– Ré6nopathie:
• Prévalence:
respec6vement
7-‐14%
et
70-‐80%
après
7-‐8
ans
et
20
ans
d’évolu6on
de
DM
• 10
à
30%
des
DM
de
plus
de
20
ans
sont
aveugles
– Neuropathie:
• Rare
chez
l’enfant
et
l’adolescent
• 50%
chez
les
adultes
DM
de
plus
de
20
ans
• Neuropathie
autonome
moins
fréquente
(5
à
35%)
mais
répercussions
plus
graves
40. Diabete
et
Pieds
-‐Toutes
les
30
secondes,
quelqu’un
est
ampute
d’un
membre
a
cause
du
diabete.
-‐Pres
de
70%
des
amputa6ons
concernent
des
personnes
diabe6ques.
-‐Jusqu’a
85%
de
toutes
les
amputa6ons
peuvent
etre
evitees
par
une
bonne
preven6on,
des
soins
de
sante
de
qualite
et
une
prise
en
charge
informee.
-‐5%
des
DM
souffrent
d’un
ulcere.
41. Morbidité
• 1ère
cause
de
cécité
chez
les
personnes
entre
20
et
74
ans
aux
USA
(12%
par
an
de
tous
les
nouveaux
cas
de
cécité)
• En
Hai6,
d’après
une
étude
de
la
Fhadimac,
en
1986,
44%
des
diabé6ques
aurait
une
ré6nopathie.
• Une
étude
de
la
SHO
“
le
jour
D”
faite
en
1999
a
trouvé
un
taux
autour
de
20%
• La
prévalence
de
la
ré6nopathie
est
directement
liée
à
l’ancienneté
du
diabète
• Son
appari6on
dépend
aussi
de
l’âge
du
pa6ent
quand
il
développe
son
diabète
42. Complica6ons
du
diabète
• On
es6me
qu’il
faut
au
moins
5
ans
d’hyperglycémie
pour
voir
apparaitre
les
lésions
cliniquement
significa6ves:
– 40%
de
ré6nopathie
après
10
ans
de
diabète
– 40%
de
néphropathie
après
15
ans
d’hyperglycémie
– Les
amputa6ons
surviennent
après
15
ans
de
diabète
43. Fardeau
du
Diabete
• Charge
psycho-‐sociale:
– Refus
d’informer
son
entourage:
pi6e,
sollicita6on
– Discrimina6on
familiale:
surprotec6on,
rejet
– Discrimina6on
au
travail:
absence;
cout
– Refus
des
assurances
a
assurer
les
DM
– Incapacite:
cecite,
deplacement
difficile
– Non-‐assistance
lors
des
urgences
(TDT:
12/1/2010)
• Cout
economique:
(72%
pop.
hai6enne
vit
avec
moins
de
$2
US/
jour)
– Choix
pour
les
depenses:
enfant
DM;
viellard;
IRT
– Choix
dans
la
prise
en
charge:
HUEH,
Chirurgie
– Prix
des
medicaments
– N’est
pas
considere
comme
une
priorite
de
sante
publique
44. Préven6on
primaire
• Les
changements
de
mode
de
vie
peuvent
prévenir
le
diabète
• La
perte
de
poids
s’accompagne
d’une
baisse
considérable
du
risque
de
diabète
• Ac6vité
physique
et
préven6on
du
diabète
45. Preven6on
secondaire
• Diabetes
Control
and
Complica6ons
Trial
(DCCT)
1
– 1441
Pa6ents
diabe6ques
de
type
1
suivis
pendant
10
ans
– Maintenir
les
niveaux
de
glucose
sanguin
dans
les
limites
de
la
normales
peut
empecher
l’appari6on
ou
du
moins
retarder
la
progression
des
dommages
causes
aux
yeux,
aux
nerfs
et
aux
reins
par
le
diabete.
46. •
UK
Prospec6ve
Diabe6c
Study
(UKPDS)
– 5102
pa6ent
de
type
2
suivis
pendant
10
ans
– Maintenir
les
niveaux
de
glucose
sanguin
dans
les
limites
de
la
normales
peut
empecher
l’appari6on
ou
du
moins
retarder
la
progression
des
dommages
causes
aux
yeux,
aux
nerfs
et
aux
reins
par
le
diabete.