On the occasion of World Diabetes Day this Sunday, November 14, a survey was carried out on the perception that the French have of diabetes*. For more than 80% of them, the risk of developing the disease is not clearly identified while its prevalence continues to increase. And patients emphasize the importance of its psychological impact and the stigma it can generate. On all these points, Why Doctor has collected the reactions of Pr Serge Halimi, diabetologist at the Grenoble University Hospital.
– Why Doctor: Diabetes today affects more than 3.5 million people in France. How is the prevalence of this disease changing?
Professor Serge Halimi: Undeniably, the increase in the prevalence of diabetes is a global reality. In France, after a period covering the last two or three decades where the rise in type 2 diabetes cases, that is to say mainly affecting adults, has been fairly constant, we have had data for about two years that show not a plateau but a smaller increase in the number of new cases. But the number of ignored cases remains by definition poorly known. We can only have hypotheses when we look at certain population samples, but we can only have a range that remains between 700,000 and 800,000 people who would be diabetic without knowing it or who would have been diagnosed but without having declared their diabetes as a long-term condition.
– A survey carried out by the IFOP for the Sanofi laboratory last October indicates that less than 20% of French people are aware of the risk of developing diabetes. Could this risk be underestimated?
This figure is indeed quite surprising. We thought that we were going to have more and more early screenings and therefore people who were not unaware of their disease. This study indicates that many people at risk of being diabetic do not know it or are not really screened, in a very high proportion and probably higher than ten years ago. It is worrying. We can think that this concerns certain populations and not others: when we are in a region with high medicalization, perhaps we are unaware that in other territories there is a lack of information, it is possible.
– Despite advances in terms of control and treatment, diabetes, according to this same survey, is still perceived as a very restrictive disease. Why ?
Seen by the general public, those who are not diabetics, diabetes is a disease that we would like not to have! There is a representation of this disease which is above all that of the injection: for everyone, the diabetic is someone who receives insulin by injection, which is not the case for a good number of so-called type 2 diabetics. But there is this image that remains quite ingrained. And for type 1 patients, young people, it is clear that it is a disease that remains restrictive despite the spectacular progress made in treatment. Nevertheless, being a diabetic treated with insulin on a daily basis remains a constraint, you have to treat yourself every day.
For other diabetics, they also keep in mind that having diabetes still means living with a burden, a risk, a sword of Damocles.
– Beyond its physical impacts, diabetes also causes psychological suffering. Are these sufficiently supported?
Maybe not enough. I think it is important to further develop consultations during which the patient has time to be listened to, modes of care in which other health actors can intervene. The new organization of care that I call for, that is to say to work more as a team, to develop health centers with doctors, nurses, psychologists, is something that would make it possible to leave more time for patients to talk about themselves and not just about the disease and its treatments. They basically need it.
– The disease would also be a cause of discrimination, even the object of dissimulation. Is diabetes a shameful disease?
There is indeed in this survey the highlighting of the “shame” aspect of having this disease. And this concerns both forms of the disease. In the form which concerns relatively young subjects who are treated with insulin, they do not want to be perceived as dependent on this treatment, to have this constraint. It’s something that, fortunately, is moving in the right direction, that is to say, it’s less stigmatizing than before, even if it remains so, undeniably. And many young diabetics prefer not to let it be known, including to their girlfriend or partner until they are truly in a relationship.
As for type 2 diabetics, even if they are not treated with insulin, they live in a situation in which they are often blamed for their lifestyle or diet. We tend to tell them – whereas when you don’t have diabetes, you often don’t make those efforts when they are necessary! – that the disease is linked to their behavior and that’s quite stigmatising.
– How is the management of diabetes evolving?
There are two categories of progression. For type 1 diabetics, those who are on insulin for their whole life with no real hope of cure, progress was made about twenty years ago with the appearance of insulin pumps which have changed things a lot. Having a pump means not having the constraint of injecting insulin several times a day since it is a flow that is adjusted by the patient and there are now sensors glycemia which allow diabetics to know at any time where they are with a lifting of anxiety, for example when they have to play sports or drive. The novelty in addition and France in this research is very well located, is that we can couple the insulin pump with these sensors to have what is called the “closed loop”, that is to say that the flow of the pump is regulated automatically, except at mealtimes. But it is a remarkable progress and it can be said that the burden of type 1 diabetic patients and all those who need insulin injections has been considerably reduced.
The other technological advances are indeed connected objects, pens that inject insulin with a programmed flow rate according to the patient’s needs and with algorithms that inform the patient in return to give him advice on managing his diabetes. . And there is also the existence of platforms that allow very easy exchanges between patients and diabetologists. At the end of all this, there are spectacular improvements in blood sugar levels with the hope of no longer exposing patients to the complications of the disease.
– And for type 2 diabetes, the one that concerns the greatest number of patients?
For type 2 diabetes, we have mainly made progress in terms of pharmacopoeia. There are new drugs that are administered orally or by injection that provide very clear benefits on blood sugar, weight and cardiac or renal protection. This changes a lot compared to a period up to the 2010s when we were relatively poor in terms of pharmacopoeia. These new molecules really change the lives of patients! But there remains the problem of access to these treatments, first in certain countries, but also in France where there are still great disparities linked to social background and the ability to focus on one’s illness. Some patients carry social burdens that do not allow them to put their energy into caring for themselves and our progress is also to be made on this side!
* IFOP study for Sanofi carried out online from October 12 to 16, 2021 on a sample of 5,022 people aged 18 and over and residing in France, including 782 people with diabetes
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