053 The Provence Diabetes network: management of patients undergoing insulin infusion therapy in South of France

Background and Objectives Continuous subcutaneous insulin infusion therapy has been in use for more than 20 years. The device was included on the list of reimbursable products and services in France in 2000. At the time, 246 patients were being treated in the Provence-Cote d9Azur region. The Provence Diabetes network was created in order to meet regional organisational needs during device deployment, to establish deployment rules, and to ensure the safety, quality and consistency of practices. Our objective was to assess the results obtained for the year 2008. Programme The Provence Diabetes network currently includes nine pioneer centres (including two paediatric centres), over 100 endocrinologists in independent practice in charge of treatment follow-up, 13 providers, four device manufacturers, state-registered nurses, dieticians, nonhospital podologists and health care institutions. Results In 2008, 275 patients started insulin infusion therapy within the network and 1193 patients were undergoing regular monitoring. Overall, 89% of scheduled patients had undergone yearly evaluation. Their average age was 46 years, 84.3% had type 1 diabetes (average duration 19.5 years). They had been on insulin infusion for a mean of 5 years. When insulin infusion therapy was initiated, their glycated haemoglobin (HbA1c) was 8.3%. By the time of the yearly evaluation, their metabolic status had markedly improved; HbAIc had fallen to 7.5% (p Discussion and Conclusions Analysis of metabolic results and patient education in patients evaluated in 2008 within the Provence diabetes network has established the efficiency and safety of continuous subcutaneous insulin infusion therapy at a regional level (better metabolic balance and few acute accidents). This was despite more widespread diffusion of the device after national health insurance coverage was granted. In addition, the network has provided added value as regards application of regulations by ensuring consistency of practices across health care centres and by professionals (common protocols and procedures), organising training, centralising medical device vigilance and making sure that everyone applies the necessary safety criteria. Contexte et objectifs Le traitement par pompe a infusion sous cutanee existe depuis plus de 20 ans. En 2000, date d9inscription au TIPS, 246 patients sont traites par pompe a insuline dans la region PACA (hors Alpes –Maritimes)- Corse. Pour repondre aux besoins d9organisation regional lors du deploiement de ce traitement, afin d9en fixer les regles et d9en garantir la qualite, la securite et l9homogeneite des pratiques le reseau Diabete Provence est cree. Programme Cette structure regroupe aujourd9hui 9 centres initiateurs (dont 2 pediatriques), plus de 100 endocrinologues liberaux de suivi, 13 prestataires, 4 fabricants de pompe, des IDE, dieteticiens, podologues liberaux et des etablissements de sante. Resultats Au cours de l9annee 2008, 275 patients ont debute un traitement par pompe a insuline au sein du reseau et 1193 sont suivi regulierement. 89 % des patients a evaluer ont beneficie d9une evaluation annuelle du traitement par pompe a insuline. L9âge moyen des patients ayant beneficie d9une evaluation annuelle en 2008 est de 46 ans, 84,3% des patients presentent un diabete de type 1, la duree moyenne du diabete chez ces patients est de 19,5 ans, et les patients sont traites par pompe a insuline depuis 5 annees en moyenne. L9HbA1c initiale de ces patients lors de la mise sous pompe etait de 8.3% et est de 7,5% lors de l9evaluation annuelle (p Conclusion L9analyse des resultats metaboliques et de l9education des patients traites par pompe a infusion sous cutanee d9insuline evalues en 2008 au sein du reseau Diabete Provence permet de confirmer, a l9echelle d9une region, l9efficacite et la securite du traitement malgre la diffusion du traitement depuis son remboursement (meilleur equilibre metabolique et peu d9accident aigu). Une des plus values du reseau est de veiller a l9application des textes reglementaires en permettant une homogeneisation des pratiques entre les differents centres et professionnels de sante (protocoles et procedures en commun), en organisant la formation des differents intervenants, en centralisant la materiovigilance et en verifiant que les criteres de securite soient bien appliques par tous.