The new HAS care course is confirming a global approach

The High Authority for Health (HAS) has just revised the care path of. Nevertheless, the adult patient living with type 2 diabetes.

It develops an integrative approach there which will have to inspire the organization of care on the. Moreover, scale of the territory to avoid inequalities. Moreover, Explanations with Jean-François Gautierteacher of endocrinology. Meanwhile, director of the university center of diabetes and its complications, in Lariboisière hospital (AP-HP, Paris).

Medscape: What do you think of this new care course?

J.-F. Similarly, Gautier : It is a very well thought out document. Furthermore, It offers a holistic approach incorporating non -medical care, such as dietetics, podology, and adapted physical activity. new care course confirming global Consequently, This care course does not forget oral health either. For example, We know that it is very important, simple descaling can reduce the HBA1C by 0.5 point! In addition,

It also clarifies the position of different health professionals. For example, The opinion of a diabetologist is necessary in several very specific situations. as for pregnancy, in the event of an unusual clinical presentation during diagnosis, complications, and punctually if the implementation of therapy requires, in particular with treatments likely to induce hypoglycemia. This rehabilitates our role. But with only 3000 endocrinologists diabetologists in France, it will not be easy to see all patients ….

We will have to work in coordination with the various doctors and caregivers. But in France, as in other European countries, the communication spaces between general practitioners and specialists are fewer and fewer. I have the feeling that a wall was erected between general new care course confirming global medicine and specialties, which complicates us a lot.

Will this approach be implemented throughout the territory?

In large centers as in Lariboisière. we have an outpatient team with a cardiologist and an ophthalmologist every day, as well as every week the visit of a hepatogastroenterologist or a neurologist. We are capable of it. This kind of center will give little ones. The philosophy of this care path encourages them to hatch them.

On a smaller scale, we can also find these approaches in health centers, with podiatrists, or psychology and dietetics consultations. But for this to work. as this care is not reimbursed over time, they must be integrated into the organization of care on the scale of the territory. ARS will have to play their role in structuring and funding this holistic care throughout France.

The new care route also highlights the telehealth. Is it possible new care course confirming global in practice?

It is an interesting aspect. When the diabetologist is equipped with a well thought out tool, our specialty is doing well on teleconsultation. It is enough for us to have the results of biological analyzes and the monitoring data. But it is nevertheless important to announce the diagnosis. to make the initial assessment during a face -to -face consultation, as is detailed in the care path.

As for remote monitoring. since this is considered a medical act of ordinary law, it works very well, in good intelligence with nurses. The patient profiles defined by health insurance are properly valued. The only difficulty lies in codification, some establishments struggling to integrate it into invoicing. Thus. while Ministry had estimated at 30,000 the number of patients likely to benefit from them, in practice, and because of these administrative difficulties, less than 4000 have access to remote monitoring.

And new care course confirming global the rest?

Logically. it would be to revise the therapeutic strategy, in order to take into account new drug approaches, such as AGLP1 associations and GLP2 inhibitors, but also technological developments, in particular for glycemic monitoring whose benefit, for patients with type 2 diabetes, is increasingly documented in the literature.

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