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Resume Alors que les recommandations sur les objectifs glycemiques chez les personnes âgees diabetiques de type 2 deviennent plus precises depuis quelques annees, il est desormais possible de mieux les adapter a la pratique clinique a l’aide d’etudes prospectives, notamment celle de la cohorte francaise GERODIAB. La synthese de ses resultats et des recentes recommandations internationales permet de definir des groupes de patients plus facilement identifiables et de proposer des objectifs d’HbA1c en tenant compte de la nature d’un plus grand nombre de medicaments antidiabetiques utilises, et notamment du risque ou non d’hypoglycemie.

Resume Bien que dans les pays occidentaux, un patient diabetique sur trois ait plus de 70 ans, les complications geriatriques et leurs relations avec la survie restent rarement etudiees. L’un des objectifs de l’etude GERODIAB etait d’examiner l’evolution des troubles geriatriques et leurs consequences sur la survie chez des patients diabetiques de type 2 âges qui conservaient une autonomie initialement suffisante. GERODIAB est une etude observationnelle prospective menee en France dans 56 centres chez 987 patients diabetiques âges de 70 ans ou plus suivis pendant 5 ans. Les caracteristiques individuelles ainsi que les parametres diabetologiques et geriatriques ont ete enregistres annuellement. Les differents scores utilises dans l’evaluation geriatrique et la frequence des hypoglycemies ont fortement augmente au cours du suivi. La vie en institution, la degradation de l’autonomie, les troubles cognitifs et les hypoglycemies etaient fortement associes a une reduction de la survie. Independamment de l’âge, le fait de vivre en institution, le score d’activite dans la vie quotidienne (Activity of Daily Living [ADL]) et une HbA1c ≥ 70 mmol/mol (8,6 %) etaient les predicteurs les plus significatifs du deces. Ces resultats confirment l’interet pronostique de l’evaluation annuelle des marqueurs geriatriques, notamment les echelles ADL, IADL et MMSE. La prise en compte de ces parametres pronostiques devrait contribuer a ameliorer la prise en charge des patients diabetiques âges et mieux cibler leurs objectifs d’HbA1c.

The present aim of the GERODIAB study was to examine the evolution of geriatric syndromes and their relationship with survival in 987 older type 2 diabetic patients over 5 years. Institutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders, orthostatic hypotension and hypoglycaemia strongly increased during the follow-up. Institutional living, impaired activities, cognitive disorders and hypoglycaemia were strongly associated with reduced survival but not falls. Our results confirm the prognostic interest of using yearly geriatric markers in older diabetic patient management. Although one in three patients with diabetes in Western countries is over 70 years-old, geriatric syndromes and their relationship with survival remain seldom studied. The present aim of the GERODIAB study was to examine the evolution of geriatric disorders and their relationship with survival in older type 2 patients with diabetes with initial sufficient autonomy. We performed a prospective, observational study over 5 years in patients with diabetes aged 70 years or above. A total of 987 consecutive type 2 patients with diabetes (mean age 77 years, range 70–94 years, 65.2% were 75 years and above, 52.1% women) were included from 56 French diabetic centres. Individual characteristics, diabetes parameters and geriatric parameters (autonomy, nutrition, cognitive alteration, depression, orthostatic hypotension, falls) were annually recorded. Survival was analysed using the Kaplan–Meier method and proportional hazards regression models. Institutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders, malnutrition, depression, orthostatic hypotension and hypoglycaemia strongly increased during the follow-up. Institutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders and hypoglycaemia were strongly associated with reduced survival, but not falls. In hazard ratio models, living in an institution (HR = 2.39; CI = 1.77–3.24; p

Resume Objectif Comparaison des interventions pharmaceutiques (IP) realisees par un pharmacien integre dans l’equipe medicale de medecine interne (analyse de niveau 3) par rapport a une analyse centralisee en pharmacie a usage interieur (PUI). Materiel et methode Une comparaison prospective est realisee durant 17 jours. Les prescriptions ont ete analysees simultanement par deux internes en pharmacie. Les parametres evalues ont inclus le nombre, la nature, la classe pharmacologique, l’impact clinique estime des IP et l’acceptation par le prescripteur. Resultats Les 180 prescriptions analysees ont fait l’objet de 121 IP. L’analyse de niveau 3 a produit 51 % d’IP supplementaires. La nature et le type d’IP etaient repartis de facon globalement homogene (p Discussion L’analyse integree au sein du service permet la production de certaines IP specifiques et ameliore la pertinence de l’analyse, notamment pour les IP a fort impact clinique. L’acces a une information plus complete du pharmacien present dans l’unite de soins explique cet etat de fait. Conclusion La connaissance des specificites de l’analyse au sein d’un service de soins est un atout pour le pharmacien clinicien conduisant a une meilleure efficacite.

This is a narrative review of telemonitoring (remote monitoring) projects and studies within the field of diabetes, with a focus on results of the more recent studies. Since the beginning of the 1990s, several telemedicine projects and studies focused on type 1 and type 2 diabetes. Over the last 5 years, numerous telemedicine projects based on connected objects and new information and communication technologies (ICT) (elements defining telemedicine 2.0) have emerged or are still under development. Two examples are the DIABETe and Telesage telemonitoring project which perfectly fits within the telemedicine 2.0 framework – the first to include artificial intelligence (AI) with MyPrediTM and DiabeoTM. Mainly, these projects and studies show that telemonitoring diabetic result in: improvements in control of blood glucose (BG) level and significant reduction in HbA1c (e.g., for Telescot et TELESAGE studies); positive impact on co-morbidities (arterial hypertension, weight, dyslipidemia) (e.g., for Telescot and DIABETe studies); better patient’s quality of life (e.g., for DIABETe study); positive impact on appropriation of the disease by patients and/or greater adherence to therapeutic and hygiene-dietary measures (e.g., The Utah Remote Monitoring Project); and at least, good receptiveness by patients and their empowerment. To date, the magnitude of its effects remains debatable, especially with the variation in patients’ characteristics (e.g., background, ability for self-management, medical condition), samples selection and approach for the treatment of control groups. All of the recent studies have been classified as “Moderate” to “High”.

Resume Le role du controle glycemique sur la mortalite des patients diabetiques âges reste peu etudie. GERODIAB est la premiere etude prospective francaise visant a decrire les liens entre l’HbA1c et la mortalite a 5 ans chez des patients diabetiques de type 2 (DT2) âges de 70 ans et plus (n = 987) en integrant les parametres diabetologiques et geriatriques. Au terme des 5 annees de suivi, 21 % des patients sont decedes, et 13 % ont ete perdus de vue ou ont quitte volontairement l’etude. Le taux de survie le plus eleve (84 %) a ete enregistre chez les sujets ayant une HbA1c moyenne durant les 5 ans entre 5,8 et 6,7 % (40-50 mmol/mol), et la plus faible survie (71 %) pour des HbA1c ≥ 8,6 % (70 mmol/mol). Entre ces deux valeurs d’HbA1c, le taux de survie etait intermediaire, tout comme pour des HbA1c 8,6 % (70 mmol/mol) etait en lui-meme un facteur suffisant pour expliquer la surmortalite. Au-dessous de cette valeur, d’autres parametres intervenaient comme, notamment, l’insuffisance cardiaque des l’inclusion. La survie etait significativement associee a la moindre variabilite individuelle de l’HbA1c et a la frequence de sa determination. Ainsi, un objectif d’HbA1c entre 5,8 a 6,7 % (40 et 50 mmol/mol) pourrait etre propose comme une cible acceptable chez certains patients DT2 âges ayant une autonomie conservee, sous reserve d’eviter les hypoglycemies.

Resume Contexte : Il s'agit d'une revue des projets de telesurveillance dans le domaine du diabete de type 1 (DT1) et de type 2 (DT2), avec une attention particuliere portee aux projets et etudes de telemedecine 2.0. Resultats : Depuis le debut des annees 1990, de nombreux projets et etudes de telemedecine axes sur le DT1 et le DT2 ont ete developpes. L'analyse de ces derniers montrent que la telesurveillance du diabete se traduit par : une amelioration du controle glycemique, une reduction significative de l'hemoglobine glyquee (HbA1c, une meilleure appropriation de la maladie par les patients, une plus grande adhesion des patients aux mesures therapeutiques et hygieno-dietetiques, un impact positif sur les comorbidites (hypertension arterielle, poids, dyslipidemie), une meilleure qualite de vie des patients, une bonne receptivite des solutions developpees, et une responsabilisation des patients au regard de leur maladie et de la connaissance de celle-ci. Jusqu'a present, l'ampleur de ses effets reste discutable, notamment au regard de la variation des caracteristiques des patients (par exemple : antecedents, capacite d'auto-gestion, etat medical), la selection des populations etudiees et l'approche adoptee pour le traitement des groupes temoins. Au cours des cinq dernieres annees, divers projets de telemedecine bases sur les objets connectes et les nouvelles technologies de l'information et de la communication (TIC) (elements definissant la telemedecine 2.0) ont vu le jour. Deux exemples sont le projet de telesurveillance DIABETe et le projet TELESAGE qui s'inscrivent parfaitement dans le cadre de la telemedecine 2.0, etant les premiers a notamment inclure une intelligence artificielle avec MyPrediTM et DiabeoTM.

The role of glycaemic control in the mortality of elderly diabetic patients remains uncertain. GERODIAB is the first multi-centre, prospective, observational study that aims to describe the link between HbA1c and 5-year mortality in French, type 2 diabetic patients aged ≥70 years.Consecutive patients (n=987; mean age 77 years) were included from 56 diabetes centres and followed for five years. Individual histories, risk factors, standard diabetes parameters and geriatric evaluations were regularly recorded. Survival was studied using the Kaplan-Meier method. Multivariable analyses used Cox regression.Twenty-one percent of the patients died, 13% were lost during follow-up. Patients with a 5-year mean HbA1c in the range [40-50) mmol/mol ([5.8-6.7) %) had the highest survival (84%); those in the range [50-70) mmol/mol ([6.7-8.6) %) or40mmol/mol (5.8%) an intermediary survival rate (79%); patients with HbA1c ≥70mmol/mol (≥8.6%) the worst survival (71%). Patients with mean HbA1c ≥70mmol/mol (≥8.6%) had a significantly higher mortality than those with lower HbA1c (P=0.011), and HbA1c remained a significant predictor of mortality after adjusting for individual, diabetic and geriatric factors (hazards ratio [95%CI]: 1.76 [1.21 to 2.57], P=0.0033). Survival was also significantly associated with both HbA1c variability and with the frequency of HbA1c determinations.In this large sample of elderly French type 2 diabetic patients, an HbA1c level70mmol/mol (8.6%) was associated with lower mortality. The range [40-50) mmol/mol ([5.8-6.7) %) could be an acceptable target provided patients are not exposed to hypoglycaemia.

International audience; Purpose To establish a consensus on both explicit and implicit criteria in order to identify potentially inappropriate prescribing (PIP) in French older people aged 75 years and over or 65 years and over with multimorbidity. Methods Fifteen experts in geriatrics, general practice, pharmacy, and clinical pharmacology were involved in a two-round Delphi survey to assess preliminary explicit and implicit criteria based on an extensive literature review and up-to-date evidence data. Experts were asked to rate their level of agreement using a 5-level Likert scale for inclusion of criteria and also for rationale and therapeutic alternatives. A consensus was considered as reached if at least 75% of the experts rated criteria as "strongly agreed" or "agreed." Results The new tool included a seven-step algorithm (implicit criteria) encompassing the three main domains that define PIP (i.e. overprescribing, underprescribing, and misprescribing) and 104 explicit criteria. Explicit criteria were divided into 6 tables related to inappropriate drug duplications (n = 7 criteria), omissions of medications and/or medication associations (n = 16), medications with an unfavourable benefit/risk ratio and/or a questionable efficacy (n = 39), medications with an unsuitable dose (n = 4) or duration (n = 6), drug-disease (n = 13), and drug-drug interactions (n = 19). Conclusion The REMEDI[e]S tool (REview of potentially inappropriate MEDIcation pr[e]scribing in Seniors) is an original mixed tool, adapted to French medical practices, aimed at preventing PIP both at the individual level in clinical practice and the population level in large-scale studies. Therefore, its use could contribute to an improvement in healthcare professionals' prescribing practices and safer care in older adults.

Iatrogenic antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) is not exceptional. Many cases of small vessel vasculitis induced by anti-thyroid drugs (ATD), mainly propylthiouracil (PTU), have been reported. We present a case of AAV related to another ATD: benzylthiouracil (BTU) and review the literature. An 84-year-old man with a 4-year history of multinodular goitre with hyperthyroidism was treated with BTU. He presented an acute syndrome with weakness, fever, epigastric pain and abdominal distension. Lactate and lipase tests were normal. An abdominal scan showed a thrombosis of the splenic artery with splenic infarction. We excluded a hypothesis of associated embolic aetiology: atrial fibrillation, atrial myxoma, intraventricular thrombus or artery aneurysm. Exploration of a possible prothrombotic state (complete blood count, haemostasis tests, activated protein C resistance, factor V Leiden, protein C, S, antithrombin III) gave normal results. Tests for antinuclear antibodies (ANA) and antiphospholipid antibodies (APL) were negative. However, testing for p-ANCA, with antimyeloperoxidase (MPO) specificity, was positive: 120.6 CU (N

Aims The main aim of the present work was to assess if sex influences the occurrence of major clinical events in elderly people with type 2 diabetes followed up in the primary care. Methods 983 subjects aged ≥65years with type 2 diabetes were included by 213 general practitioners and followed up prospectively for three years. Major clinical events were recorded every six month. The first endpoint was a composite of all-cause death and major vascular events (acute coronary syndrome, non-fatal stroke or transient ischemic attack, or revascularization for peripheral artery disease). The second endpoint was all-cause hospitalization. The occurrence of each endpoint was analyzed in order to estimate the role of sex and determine other predictors of major clinical events. Results At baseline, women were older than men but they had a lower prevalence of coexisting diseases (cardiovascular disease and cancer) and equivalent diabetes control (Glycated hemoglobin A1C: 6.9%±0.9 vs. 7.0%±1.1). Over the follow-up period, women were at lower risk to develop the composite endpoint (HR 0.60, 95% CI 0.40-0.91, p=0.016) and the hospitalization endpoint (OR 0.71, 95% CI 0.52-0.96, p=0.029). Coexisting diseases, functional ability and concomitant medications emerged as significant predictors of both endpoints. Conclusions Elderly women with well-controlled type 2 diabetes were less likely to experience major clinical events than their male counterparts. More studies are needed to determine the reasons for the higher hospitalization rate in men.

Resume La carence en vitamine B12 reste une anomalie biologique frequente chez le sujet âge. Son retentissement clinique et ses etiologies diverses et variees constituent un reel defi pour le geriatre. En effet, son diagnostic est souvent difficile car la symptomatologie clinique et biologique est tres souvent fruste et non specifique, notamment chez le sujet âge. La prise orale est une alternative interessante pour traiter la carence en vitamine B12 dans cette population.

Digitalis remains a treatment that is difficult to manage, especially in the elderly. Methods A retrospective, unicentric study carried out within the unit of Internal medicine and geriatrics, Reims University Hospital Center, between January and June 2014. Collection of all patients hospitalized, after 75 years, receiving treatment with digitalis, either as soon as they enter (present on the usual prescription of the patient), during their hospitalization and on their exit. Results 20 patients were included. The median age was 89 years (range: 78-94). Digitalis was only used in slowing down the ventricular rate during atrial fibrillation; 7 patients (35%) had a high serum digoxin concentration, of which 4 had renal failure. Three patients presented a digital cup on the electrocardiogram. In our series, in digoxin overdosage, 3 patients with electrical signs of digoxin overdosage have all 3 digoxin-beta-blockers. We are in the limit of the significance, for the connection between digoxinemia and the appearance of electrical signs of overdose in digitalis (p=0.06). Conclusion Digoxin therefore remains a drug that is difficult to manage, mainly in the elderly, as there are many clinical, biological drug and therapeutic constraints. Failure to comply with the rules for the use and monitoring of digoxin may prove fatal in the elderly.

El tratamiento de la diabetes del paciente anciano representa un reto de salud publica, y el medico general es el que se encuentra en el centro del sistema de salud para este paciente particular. Tiene que individualizar el tratamiento, pero teniendo en cuenta la dimension geriatrica del paciente y, en particular, el exito de su envejecimiento. Debe centrar la atencion en la deteccion de la fragilidad, la desnutricion, los trastornos cognitivos y la hipoglucemia. Todas estas complicaciones a menudo se pasan por alto o se subestiman, aunque tienen consecuencias graves sobre el pronostico del paciente.

Objective The study aimed to compare the drug therapy profile between French older adults with diabetes of the GERODIAB cohort and Brazilian older adults with diabetes assessed in a cross-sectional study conducted in Brazil. Method This quantitative cross-sectional study was conducted with a sample of 246 Brazilian people aged 65 and over receiving care through the Unified Health System in the city of Fortaleza, Northeastern Brazil, who were compared to a sample of 987 French people aged 70 and over receiving care the Rouen University Center in France. Results The French participants treated for type 2 diabetes (T2D) with insulin alone, insulin + oral hypoglycemic agent (OHA) or OHA/GLP-1 analogue were older and presented higher mean values for body mass index, waist circumference and duration of diabetes in years. The French reported more episodes of hypoglycemia in all treatment modalities. These episodes occurred more frequently in the older adults treated with insulin alone and less frequently in those treated with OHA or GLP-1 analogues. The percentage of Brazilian and French older adults who monitored capillary blood glucose differed significantly in all treatment modalities. Conclusion The significant differences relating to the drug therapy modalities used by Brazilian and French older adults with diabetes point to the importance of understanding the therapeutic objective of drug therapy with older adults with diabetes. Adapting the therapy to the patient’s clinical conditions can prevent the worsening of comorbidities that influence the loss of autonomy and frailty.

Currently, the in vivo distribution of drugs is investigated by non-spatial quantitative techniques. With the emergence of personal therapies using nanomedicines, deeper investigations are required to precisely know the in vivo fate of entrapped drugs, especially to predict possible toxicity. Here, we assess the capabilities of SR-μXRF for i) detecting drugs into nanomedicines without adding any marker, ii) mapping their distribution into tissues and iii) locally quantifying the drugs loaded into nanomedicines. To prepare the nanomedicine model, we used the bioconjugate diamine(dichloro)platinum (SQ-CDD) developed in the TERNANOMED Grant Project. Nanomedicines were intravenously injected into a nude mice model bearing a pancreatic tumour (PANC-1). The X-ray microfluorescence experiments were performed on embeds tissue sections of kidney and tumor at 2h and 24h after nanoparticles injection. Data collection was performed on the micro-imaging beamline ID13 of the European Synchrotron Radiation Facility (ESRF). A quantitative study was performed by atomic absorption spectroscopy (AAS), allowing to compare the platinum concentrations with those measured by X-ray. This study shows that the synchrotron radiation-based μXRF analysis is sensitive enough to detect and map the distribution of a drug entrapped into nanomedicine. A quantitative local analysis is possible with a tissue element as reference, or semi-quantitatively if the tissue reference is not homogenous.

Resume • L’etude S.AGES avait pour objectif principal de decrire les caracteristiques cliniques et les modalites de prise en charge des patients diabetiques de type 2 (DT2) âges, suivis en France en medecine generale. • Il s’agit d’une etude de suivi de cohorte, non interventionnelle, nationale et multicentrique, qui a inclus 959 patients DT2 âges de plus de 65 ans, suivis par 227 medecins generalistes. Les resultats a l’inclusion montrent qu’une proportion importante de ces malades presentait une HbA 1c

Introduction En 2016 etait publie un guide sur les interruptions de tâche (IT) par la Haute Autorite de sante (HAS) en tant qu’outil de securisation du circuit des medicaments, l’IT etant un facteur contributif d’erreurs medicamenteuses, et donc une situation a risque pour le patient, alors qu’elles sont socialement percues comme un fonctionnement normal. Materiels et methodes Dans un service de medecine interne polyvalente a ete realisee une etude prospective quantitative observationnelle en trois phases : – premiere phase d’observation des soignants (infirmieres [IDE] et aides-soignantes [AS]) et medecins (seniors et internes) a des moments-cles de la prise en charge medicamenteuse des patients, avec recueil des caracteristiques de l’IT (circonstances, « interrupteur », motif, gravite, duree) ; – elaboration d’axes d’amelioration par l’equipe medicale et paramedicale du service ; – deuxieme phase d’observation (avec meme donnees recueillies) afin d’evaluer le retentissement des actions. Resultats Premiere phase : 493 IT ont ete relevees sur 47 temps d’observation (91,5 heures). Les IDE etaient les plus interrompues (7,2 IT par heure, en particulier lors de la preparation du pilulier : 13 IT/h), puis les seniors (5,2 IT/h ; en particulier lors de la contre-visite : 7,2 IT/h), les AS (4,1 IT/h) et les internes (3,9 IT/h ; surtout lors de la contre-visite : 5,7 IT/h). La majeure partie des IT etaient « physiques » (84 % pour les IDE, 94 % pour les AS, 89 % pour les seniors et 100 % pour les internes) et induites par des tiers professionnels (64 % pour les IDE, 61 % pour les AS, 68 % pour les seniors, 77 % pour les internes). Les deux principaux motifs d’IT etaient la recherche d’information et l’apport d’information (42 % et 20 % respectivement pour les IDE, 44 % et 15 % pour les AS, 34 % et 40 % pour les seniors et 58 % et 23 % pour les internes). Les discussions personnelles etaient aussi un motif notable d’IT (16 % pour les IDE, 9 % pour les AS, 10 % pour les seniors, 11 % pour les internes). Les axes d’amelioration ont ete les suivants : – point quotidien de 17 h entre medecins et soignants ; – guide d’accueil des internes et des externes ; – paravent d’« invisibilite » ; – verification systematique a l’arrivee du dossier informatique par les AS ; – meilleure lisibilite de la pancarte et relais du telephone pour la preparation des piluliers ; – familles : personne referente, informations selon champ de competence, secretariat pour prise de rendez-vous ; – sensibilisation avec presentation des resultats. Deuxieme phase, 478 IT ont ete relevees sur 49 temps d’observation (97,5 heures). Les IDE etaient moins interrompues (−27 %, en particulier lors de la preparation du pilulier : 7,1 IT/h, soit −54 %), de meme que les internes (−9 %), en particulier lors de la contre-visite : −51 %. Les seniors avaient un nombre d’IT augmente (+12 %) malgre une nette diminution des IT de la contre-visite (−56 %), de meme que les AS (4,45 IT/h : +9 %, en particulier sur le quart du soir [4,7 IT/h : +24 %]). Les IT induites par les tiers professionnels etaient moindres pour les IDE (−30 %), augmentees pour les seniors et les AS (+31 % et +10 % respectivement) et stables pour les internes. Les IT liees aux discussions personnelles diminuaient nettement (−94 % pour les IDE, −86 % pour les AS, −100 % pour les seniors, −48 % pour les internes). Les IT non urgentes etaient diminuees (−58 % pour les IDE, −34 % pour les seniors, −60 % pour les internes), et discretement augmentees pour les AS (+10 %). La perte de temps totale generee par les IT etait globalement en diminution pour les IDE (−12 %) et les seniors (−10 %), mais en augmentation pour les AS (+10 %) et les internes (+52 %). Conclusion Les IT sont frequentes et banalisees, notamment lors de la preparation des piluliers. Les mesures correctives mises en place ont permis de limiter certaines IT « evitables », en particulier les discussions personnelles et les IT liees aux familles. Certains moments ont eu une nette amelioration (piluliers, contre-visite), mais d’autres necessitent encore de trouver d’autres axes d’amelioration.

The objective of the GER-e-TEC™ project is to provide a personalised medical follow-up of residents in nursing homes with the aid of a telemedicine intelligent platform. It will assist the nursing staff by automatically processing information obtained from sensors and questionnaires in order to give an early warning about high-risk situations. This telemedicine tool will enable health professionals to optimise residents' care.

Diabetes mellitus (DM) is a risk factor for periodontitis for over 40 years and novel evidence suggests that periodontitis has an impact on glycemic control in patients with diabetes. This study aimed to compare oral health complications in diabetic older patients from Brazil and France.This cross-sectional study included 120 patients aged 65 and over diagnosed with type 2 diabetes. Sixty patients were admitted to a center for diabetes and hypertension care in Brazil and 60 patients were admitted to the Rouen University hospital. Dental conditions were assessed through the decayed, missing and filled teeth index and periodontal condition was assessed using the Community Periodontal Index. The significance threshold was p 0.05.Decayed teeth differed statistically between the groups (p = 0.001). The French group presented more tooth mobility, gingival recession and furcation involvement (p 0.001). Tooth brushing frequency differed significantly between the groups (p 0.030). The main cause of missing teeth was periodontitis in the French group and caries and periodontitis in the Brazilian group (p 0.001). Statistical significance was found for use of fixed upper (p = 0.013) and lower (p = 0.013) dentures in the French group. The French group needed upper denture rehabilitation (p = 0.010) while the Brazilian group needed lower denture rehabilitation (p = 0.003).Edentulism was prevalent in diabetic older people in both countries. However, the French participants presented with better oral health.

International audience

The use of physical restraint with the elderly remains a much-debated topic. Its use remains criticised and is also something of a paradox given its practice in this kind of facilities. All health professionals may use it in their daily practice, in a wide variety of situations.

RESUME L’etude Gerodiab est la premiere etude multicentrique francaise observationnelle prospective de suivi d’une cohorte de patients diabetiques âges. But de l’etude : L’objectif de cette etude est d’evaluer le lien entre l’equilibre glycemique et la morbidite de patients diabetiques de type 2 de plus de 70 ans. Les resultats ici presentes concernent les donnees lors de l’inclusion des patients. Patients et methode : Une cohorte de 987 patients diabetiques de type 2 dont 52,1 % de femmes, âges de 70 ans et plus, ont ete inclus de Juin 2009 a Juillet 2010 apres une information eclairee, dans 56 centres repartis dans l’hexagone. L’anciennete du diabete etait d’au moins 1 an et les malades devaient etre suffisamment autonomes dans leurs activites de la vie courante comportant notamment l’hygiene corporelle, l’habillage, la marche et les repas. Cette autonomie, au moins relative, etait definie par un score superieur ou egal a 3/6 sur l’echelle ADL (Activities of Daily Living) Les criteres d’exploitation de l’etude reposaient, lors de l’inclusion, sur l’evaluation des donnees individuelles et notamment sur l’existence de troubles cognitifs. Dans cette etude, les troubles cognitifs ont ete quantifies grâce a la realisation d’un MMSE (Mini Mental State Examination). Resultats : Dans l’etude Gerodiab, 28,7 % des patients avaient un deficit sur le plan cognitif, soit du fait d’une demence (2,6 % des cas), soit devant un score inferieur a 25 au MMSE lors de l’inclusion. Les resultats permettent de confirmer et de preciser certains points de la litterature portant sur la frequence, les mecanismes d’apparition, le role des hypoglycemies et les consequences cliniques de ces troubles cognitifs. Conclusion : Le depistage des troubles cognitifs des patients diabetiques âges permet d’adapter le mode de prise en charge et de prendre des mesures sociales pour limiter les consequences de ce qui constitue de nouvelles complications du diabete.

Adaptation of drug dosage to kidney function is a common problem in general practice. The aim was to describe adaptation of cardiovascular drugs and metformin according to renal function and its association with mortality with regard to metformin in a cohort of elderly patients. This was an ancillary study to the S.AGES cohort made up of patients over 65 years of age managed by their general practitioner under real-life conditions and followed up prospectively for 3 years. The medications studied were digoxin, spironolactone and metformin. Adaptation of their daily dose according to renal function (eGFR according to CKD/EPI) was compared to that recommended in the summaries of product characteristics (SPCs) or international scientific societies (ISS). A total of 900 patients were included, including 588 on metformin. At baseline, dose adjustment according to renal function was 100% and 87.6% (95% CI: 82.6-92.6) for patients on digoxin and spironolactone respectively. For metformin, only 71.3% (95% CI: 67.6-74.9) or 78.1% (95% CI: 74.7-81.4) of patients had their dosage adapted at inclusion according to their renal function depending on whether the SPCs or ISS recommendations were considered. During the 3-year follow-up period, 42/588 patients died (none from lactic acidosis). At inclusion, a metformin dosage not adapted for renal function according to ISS was not associated with an increase in all-cause mortality (OR 1.7; 95% CI 0.6-5.0, p = 0.32). In conclusion, approximately one-quarter of elderly patients treated with metformin do not have their dosage adapted for renal function according to ISS although there is no increase in mortality after follow-up for 3 years.

Hypervitanimia B12 is an early marker of serious pathologies. These include solid neoplasms, malignant blood diseases and acute/chronic hepatopathies. Hypervitaminemia B12 in geriatrics is thereby an indicator in the diagnosis and prognosis of these conditions.

Horton disease is difficult to diagnose in the elderly, due to the non-specificity of clinical signs. When evoked in the case of recent headaches, laboratory tests must be carried out to look for signs of inflammation.

Introduction et but de l’etude La vitamine D est essentielle dans la prevention des chutes et dans la prise en charge de pathologies osseuses. La HAS ainsi que l’Assurance Maladie recommandent le dosage de la vitamine D dans les situations suivantes : patient a risque de chutes a repetition (dont patients denutris severes), medicaments inducteurs de carence, osteomalacie, rachitisme, transplante renal, chirurgie bariatrique. La supplementation en vitamine D fait l’objet de recommandations et semble insuffisante en medecine de ville. Le statut vitaminique D des patients (identification des situations avec une indication au dosage et supplementation) est-il re evalue en medecine aigue et quelle est la place des patients denutris severes qui releveraient d’une evaluation du statut vitaminique ? Materiel et methodes Il s’agit d’une etude observationnelle retrospective. Les criteres d’inclusion sont les patients sortis de 2 services de medecine aigue (medecine interne et geriatrie) du 01/12/18 au 31/12/18. Les patients deja supplementes ont ete analyses de facon independante. Les criteres d’exclusion sont les deces et l’hypercalcemie vraie. Parmi les patients a risque de chutes repetees ont ete differencies les chuteurs averes definis par au moins deux chutes au cours des 12 derniers mois des patients denutris severe. Le dosage de vitamine D, la supplementation en vitamine et ses modalites etaient recueillis. Resultats et analyse statistique Nous avons etudies 238 dossiers patients. Vingt deux patients ont ete exclus (21 deces et 1 hypercalcemie). La moyenne d’âge 85 ans (± 0 ans ; Sex ratio 78/138). 187/216 (87 %) patients relevaient d’une supplementation. Dans ce groupe, 43/187 (23 %) etaient deja supplementes a l’entree. Parmi les 144/187 (77 %) non supplementes en ville : 72/144 (50 %) avaient une indication au dosage de vitamine D : risque de chutes a repetition chez 72/72 (100 %) dont 39/72 (54 %) chuteurs averes et 33/72 (46 %) denutris severes. Aucun de ces 72 patients n’a beneficie du dosage recommande. La place des patients denutris severe represente 33/144 (23 %) des patients necessitant une supplementation. 72/144 (50 %) n’avaient pas d’indication au dosage mais etaient soit osteoporotiques, soit âges de plus de 65 ans et en perte d’autonomie avec une exposition solaire insuffisante relevant d’une supplementation trimestrielle. Seuls 33/187 (18 %) ont beneficie de vitamine D a la sortie, de galeniques et posologies diverses. Pour 23/43 (53 %) des patients deja supplementes, la vitamine D n’a pas ete reconduite. Parmi les patients non supplementes en ville, seuls 13/144 (9 %) ont beneficie d’une introduction de vitamine D. Conclusion Nos resultats montrent que la reevaluation du statut vitaminique D et la prescription de vitamine D semblent tres insuffisants en medecine hospitaliere aigue mais egalement en medecine de ville. Une sensibilisation sur cette thematique est necessaire, surtout chez le patient a risque de chute et notamment les denutris severes.

This study aimed to compare the sociodemographic and epidemiological profiles between Brazilian and French older people with type 2 diabetes mellitus.Quantitative analytical study of 248 type 2 diabetes patients aged 65+ years receiving care in a center for integrated diabetes and hypertension care. The data were compared with the GERODIAB study conducted in France.The participants' mean age was 73.16 ± 6.4 years, with 162 (65.4%) participants aged less than 75 years and 38 (15.3%) over 80 years old. Almost all the participants (99.2%) lived at home, 35 (14.1%) were uneducated, and 17 (6.9%) had completed higher education. The majority (232 older people) were retired. Most of the median values of the variables differed statistically (p 0.001) between the two populations. Peripheral vascular disease, diabetic neuropathy, foot wound, amputation, hypoglycemia, hyperosmolarity and other intercurrent infections differed statistically (p 0.001) between the two populations. Most of the medication use variables differed significantly (p 0.05) between Brazilians and the French.The statistically significant differences between the two populations reveal better conditions among the French participants, which highlights the importance of the scientific evidence found in the French study for developing public health actions targeted at Brazilian diabetic older people.