Spécificités dans la prise en charge de patients diabétiques dans le contexte multiculturels de l’Ile Maurice.

The main objective of this research is to describe the situation of diabetic complications in the multicultural contest of Mauritius in people adherent to community-based care. The research is further divided in three main parts.

Firstly, to assess the diabetic situation in Mauritius based on the data collected at APSA Diabetes Care Centre (ADCC). This study shall be a descriptive analysis of people living with diabetes and its associated complication (diabetic foot) in Mauritius. It shall be a longitudinal analysis of changes in patients’ clinical status from June 2021 to March 2023. There shall also be a stratified descriptive analysis according to patients’ community or cultural affiliation. The latter shall be the first epidemiological study in Mauritius with a significant number of diabetic patients, namely, 1278 patients consisting over 5359 consultations at ADCC. The expected results shall analyse the hypothesis of a possible link between diabetes management and cultural/community affiliation. To see the correlation of a calendar variations in clinical data with cultural and community practices, and lastly a description of diabetic complications associated with tropical insularity particularly the diabetic foot. As till date (2022/2023), all data has been collected, treated, and cleaned. The literature review of this first study is currently in process, statistical analysis is being finalised. Following which (2023/2024) the article shall be written and submit in a journal.

Secondly, to conduct a cost-effectiveness comparative study of two therapeutic education strategies used in a period of six months in Mauritius. In this study, a comparative analysis between result (HbA1c evolution) from 100 patients who have undergone a cycle of 7 education sessions shall be compared with 100 patients having received only 2 education sessions against a control group of patients who did not receive any therapeutic education. The objective of this second study is to identify the most effective strategies of therapeutic education to help patients living with diabetes in Mauritius. A medico-economic analysis of the best strategy using the ICER (Incremental Cost Effectiveness Ratio) technique shall also be conducted. Following the analysis of data collected, we shall be able to produce recommendations for cost-effective delivery of therapeutic education sessions and to provide a record of advocacy for the public system and NGOs in Mauritius. As till date (2022/2023), all data has been collected, digitalised, treated, and cleaned. The literature review of the study is currently in process, statistical analysis is being finalised. Following which (2023/2024) the article shall be written and submit to a journal.

And lastly, a pilot study of the ‘IoT-HD’ program (Internet of Things for Hypertension and Diabetes Program). The aim of this study is to measure the adherence to connected devices in patients living with diabetes in Mauritius. For this comparative study, a set of 1,2,3 or 4 connected devices shall be attributed to selected patients for a period of 3 months. The patients shall be provided with recommendations for proper use of connected objects. Then using the ‘adapted Morisky’ scale to measure the adherence after 3 months of devices allocation. A questionnaire shall be designed to identify the barriers and to optimise the levers for adherence to connected devices. We expect for this study to be able to demonstrate the feasibility of the IoT-HD program. As till date (2022/2023), all patients have been identified and group of connected devices has been purchased. Guidelines and protocols of usage has already been drafted. The literature review of this third study is currently in process, data collection and statistical analysis shall then follow with recommendations for the IoT-HD program (2023/2024).

Mots clés : Diabète, Éducation thérapeutique, IoT-HD, Complications diabétiques, Analyse coût-efficacité