[Chronic kidney disease, an often underestimated complication of diabetes]. / L'insuffisance rénale chronique, une complication du diabète souvent sous-estimée.

Diabetic kidney chronic kidney disease, an often underestimated complication of diabetes. Diabetic kidney disease is a serious complication which can evolve into severe chronic kidney disease (CKD), or even end-stage renal disease (ESRD). It impacts on the patient's quality of life and that of their family and significantly increases the cost of care. The development and progression of chronic kidney disease is prevented by strictly controlling blood sugar levels and cardiovascular risk factors as well as monitoring the markers of kidney disease. In the case of CKD, treatment may need to be adapted.

[Diabetes and tobacco, a dangerous combination]. / Diabète et tabac, une association dangereuse.

Smoking is a worldwide health problem. In regular smokers, the risk of developing type 2 diabetes is high. In people with diabetes, smoking significantly worsens microangiopathic, cardio- and cerebrovascular complications.Therefore, helping people with diabetes or at risk of diabetes to give up smoking is crucial.

[Technological innovation in diabetes: is it suitable for everyone and at what price?]. / L'innovation technologique dans le diabète: pour tous? A quel prix?

Tools for monitoring diabetes such as glucose testing devices, continuous glucose monitoring and telemedicine in particular, those for treating the disease such as insulin pens and pumps, or the "artificial pancreas", are constantly improving thanks to technological advances, which also concern preventative treatments. However, these new techniques are particularly costly. They also require considerable investment from the multidisciplinary nursing team in terms of therapeutic patient education.

Results and analysis of the 2008-2009 Insulin Injection Technique Questionnaire survey.

BACKGROUND: The efficacy of injection therapy in diabetes depends on correct injection technique and, to provide patients with guidance in this area, we must understand how they currently inject. METHODS: From September 2008 to June 2009, 4352 insulin-injecting Type 1 and Type 2 diabetic patients from 171 centers in 16 countries were surveyed regarding their injection practices. RESULTS: Overall, 3.6% of patients use the 12.7-mm needle, 1.8% use the 12-mm needle, 1.6% use the 10-mm needle, 48.6% use the 8-mm needle, 15.8% use the 6-mm needle, and 21.6% use the 5-mm needle; 7% of patients do not know what length of needle they use. Twenty-one percent of patients admitted injecting into the same site for an entire day, or even a few days, a practice associated with lipohypertrophy. Approximately 50% of patients have or have had symptoms suggestive of lipohypertrophy. Abdominal lipohypertrophy seems to be more frequent in those using the two smaller injection size areas, and less frequent in those using larger areas. Nearly 3% of patients reported always injecting into lipohypertrophic lesions and 26% inject into them sometimes. Of the 65% of patients using cloudy insulins (e.g. NPH), 35% do not remix it before use. CONCLUSIONS: It is clear from the latest survey that we have improved in certain areas, but that, in others, we have either not moved at all or our efforts have not yielded the results we expected. The results of the present survey are available online on a country-by-country and question-by-question basis at http://www.titan-workshop.org.