This guide to the High Authority for Health (HAS) describes “ care, support and overall follow -up of adults »With type 2 diabetes, and complements the recommendations released in June 2024 on therapeutic strategies, including non -drug. Tolding all professionals in the health, social and medico-social sectors, it consists of several documents: an overview of the care path, a chronological care plan ” Describing minimum management monitoring », A syntheses of critical points of the care path, 14 key messages to improve practices, and a sheet on the Place de la Télésanté in care.
An alternating care pathway reports and follow -up consultations
The chronological care plan thus opens with an initial assessment, which consists of ” Evaluate the overall health and clinical condition of the patient And which is based on a checklist to sweep with it (age, smoking, assessment of sedentary lifestyle, food, assessment of overall cardiovascular risk, identification of weaknesses and complications, etc.). This assessment can be carried out by the general practitioner as well as by a nurse, in collaboration with the doctor (nurse under cooperation protocol, including Asalée, nurse in advanced practice, in particular). A follow -up consultation is then organized every three months, there also framed by a checklist, with after a year, a new location of vulnerabilities and a renal, lipid, cardiac and hepatic assessment; A gradation of the risk of developing a diabetic foot is also planned. The alternation consultations/balance sheets then reproduces from one year to the next. “” In the presence of complications, additional specialized follow -up must be implemented (ophthalmologist, cardiologist, nephrologist, etc.) Adds the has.
14 key messages to cover all of the care
The 14 key messages have been developed to help healthcare professionals improve their care.
- They open up to a screening action, which ” is based on the identification of risk factors »
- It is followed by the diagnosis. A differential diagnosis, made by a doctor specializing in diabetology, is necessary in the event of an unusual presentation (patient under 40, absence of overweight, etc.)
- In case of diagnosis of prediabete, the HAS recommends « aware of the patient at the risk of developing »Subsequent type 2 diabetes and complications that it can causeand ” Encourage it to adopt prevention measures focused on a modification of the lifestyle.»
- « A dedicated ad consultation to inform and exchange with the patient explains the pathology in order to define with him realistic objectives and care adapted to his situation “, Continues the has, which specifies:” The therapeutic changes in the lifestyle are an essential prerequisite for the possible implementation of drug treatment. »
- Are mentioned in particular fight against sedentary lifestyle, practice of regular physical activity, improvement of food quality and balance, stopping smoking …
- This change in lifestyle is accompanied by a personalized dietetic care plan, set up with a dietitian and ” avoiding any excessive food restriction ».
- Drug treatments only occur in the second intention, if non -drug measures have not made it possible to achieve the set objectives.
- To therapeutic strategy, Added to the patient’s therapeutic education (FT)who “fhave an integral part of global care “And who” gives an active role to the patient aiming to make him acquire self -management and auto -centers necessary for the daily management of pathology. These ETP sessions can be individual and collective and are provided by professionals trained in this type of action.
- HAS also recalls the need to integrate the patient’s journey with type 2 diabetes into a multidisciplinary team in primary care : treating doctor, nurse, dietitian, adapted physical activity professionals, podiatrist, pharmacist, even psychologist if necessary.
- If the situation the need or if it is deemed too complex by the attending physician, the addressing to a specialized doctor is required.
- Throughout the course, measures to screen for complications (ophthalmological, cardiovascular, neuropathic, chronic kidney disease) must be carried out.
- And they are accompanied by a “DSystematic annual epistage of podological risk by gradation of the risk of wounds », This to determine the number of necessary care sessions.
- You also have to take into account ” life expectancy, fragility and comorbidities Before any intervention on lifestyles, in order to best adapt the glycemic objectives, and avoid hypoglycaemia. Elderly patients are more exposed ” At the risk of undernutrition due to modifications to appetite, decrease in physical activity, polymedication, comorbidities or the presence of a depressive state which exerts a negative influence on food intake. Restrictive regimes, a fortiori in this population, should be avoided “, Recalls the has.
- Finally, lastly, the health agency recommends taking into account ” Psychological impact From the disease by identifying signs of mental suffering, any anxious, depressive or food disorders, from the initial assessment.
« Developed in co -production with professionals and users of the health system, these short messages aim to encourage healthcare professionals to initiate dialogue with patients about the best indicated exams, treatments and interventions and to identify those who are not necessary “Concludes the has. In 2023, 4.2 million people suffered from this chronic pathology.
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