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In both cases, although progressive co-construction of a new relationship to the body and “others” was observed as a result of physical activity, the interactions between all partners in the “trajectory” demonstrate a time aspect to involvement in “the physical activity career”, that is specific to each patient..

Muscular exercise promotes glucose utilisation by the skeletal muscle, independently of insulin action, by activating the AMP-activated protein kinase (AMPK). This process is not altered in patients with obesity and/or type 2 diabetes, despite the presence of insulin resistance. Thus, exercise should play a key role in the management of type 2 diabetic patients. Regular physical activity enhances insulin sensitivity, improves glucose control and corrects some cardiovascular risk factors. This paper briefly presents some practical recommendations about physical activity in obese and/or type 2 diabetic patients.

Type 2 diabetic patients followed in primary care rarely benefit from a structured educational approach in spite of the fact that the intervention of a multidisciplinary team has proven its efficacy for improving metabolic control. We describe a pilot project, which aimed at implementing an ambulatory multidisciplinary programme and at evaluating the feasibility of an educational module in type 2 diabetic patients followed in primary care. Four general practitioners (GP) selected 25 type 2 diabetic patients, not well controlled or with poor knowledge of their disease. Fourteen health care providers developed an intervention module comprising, over 4 months, an initial interview with the GP, three interviews with a dietician, two with a nurse and three with a psychologist. Besides studying the feasibility of the project, the primary objective was to analyze the subjective feeling of both patients and heath care providers participating to the project. A secondary objective was to compare some parameters of control (HbA1c, body weight) before and after the intervention in these 25 patients, and in 10 control patients followed as usual in general practice. The multidisciplinary educational intervention was well appreciated by diabetic patients whose adhesion was excellent. Health care provider's mobilization was enthusiastic, and all emphasized the human positive aspects of such a multidisciplinary approach. Preliminary analysis demonstrates beneficial effects of the educational programme.

Though the importance of self-monitoring blood glucose (SMBG) for type 1 diabetes is widely acknowledged, it is still questioned in type 2 diabetes, at last when it is not treated with insulin. Indeed, SMBG appears to be efficient only when it is integrated into a strategy of self-treatment, which leads the patient to adapt his treatment to his blood sugar tests. Passive self-control is useless, and can even favour increasing anxiety or frustration. Numerous problems are still to be solved, be it concerning the adaptation of the treatment - the number of tests per day or per week, the kind of therapeutic adaptation, etc - or concerning the therapeutic education, which should correspond to the patient's personality and to his strategy of treatment. Evaluating the locus of control of the patients could help to single out those who could benefit from SMBG. The development of SMBG, whose cost is financed by social Security in France, is a good mirror of the patients' increasing wish to be informed about their treatment and to take an active part in it. Yet prospective randomised studies are still needed to confirm the efficiency of SMBG in type 2 diabetes.

The aim of this study was to help improving management of patients with type 2 diabetes by evaluating their knowledge of the disease and its treatment and by identifying factors which might influence management. A questionnaire was sent to diabetic patients taking oral antidiabetic drugs affiliated to one of the three main national health insurance schemes in the French Departments Seine-Maritime and Eure. Four hundred responses were analyzed. Patient knowledge of diabetes and its complications, follow-up, surveillance and dietary control were rather poor. Use of a personal diary (used by 24%) was associated with better knowledge of the disease and better participation in follow-up and treatment. Actions aimed at better education of diabetic patients promoting use of a personal diary would be helpful to improve disease management, necessary to reduce the risk of complications.

In diabetes, the links between long-term complications and chronic hyperglycaemia and the risk of hypoglycaemia during intensive treatment have been well-documented. However, the potential short- or long-term benefits of glycaemic control on quality of life and cognitive functions have generally been reported as minimal or nil. Patients do not perceive the connection between better glycaemic control and quality of life. The potential advantages of Ozidia, whether in terms of glycaemic control, tolerance or ease of use, suggest that this treatment may provide improved quality of life. Two studies have investigated this possibility. The first, carried out over a 16-week period in the United States, was a randomised double-blind Ozidia vs placebo study in 594 non-insulin-dependent (NIDDM) diabetic patients to evaluate the respective influences of glycaemic control, symptoms of hyperglycaemia and side-effects of treatment on quality of life. The results were important, indicating a decrease in short-term clinical symptoms and an improvement in the quality of life, in correlation with decreased HbA1C. The quality of life of NIDDM patients can be improved by stricter glycaemic control, and thus can modify in the choice of therapeutic strategies and cost-benefit evaluation of intensive glycaemic control. The second study now under way in France concerns an evaluation of the quality of life of NIDDM patients before and after treatment with Ozidia. More than 600 diabetologists are involved, and the study should include 1,500 patients. The purpose is to show that Ozidia effectively improves quality of life by encouraging treatment compliance and improving treatment effectiveness. Thanks to self-monitoring of glycaemia, patients can measure the efficacy of their treatment regularly at various times of the day. A dose 5 to 15 mg/day of Ozidia is administered in this open 12-week study. The results will not be available before the end of 1997.

Structured teaching and treatment programmes for Type-II non insulin dependent diabetic patients have been proved in several studies to be cost effective. K. Davidson in Atlanta described the considerable decrease of health care costs after the introduction of his programme. Recently a similar programme was introduced into the German health care system and physicians in private practice are remunerated for providing the programme. Until now more than 10,000 physicians have participated in postgraduate courses, which are the prerequisite to be remunerated. The evaluation of the programme including a cost benefit analysis demonstrated the financial benefits of the programme even in a short time. The methods of nation-wide multiplication of the programme and its contents are summarised in this article. The principles of the treatment strategy follows the objectives which have been published already in 1875 by A. Bouchardat: Urine testing, hypocaloric diet and exercise.