Introduction:The non-adherence to therapy of diabetics is grafted with heavy morbidity and mortality. Our study aims to determine the factors of non-adherence with antidiabetic drugs in type 2 diabetics. Methods: This was a descriptive and analytical cross-sectional study, carried out in the Endocrinology Unit of the Joseph Raseta University Hospital Center. Befelatanana, Antananarivo, over a period of 7 months. Adherence to treatment was assessed by the Morisky scale. Results: We retained 104 patients with an average age of 58.36 years, consisting of 52.88% of women. Adherence was high, medium, and low in 6.73%, 31.73% and 61.54% of cases, respectively. From their attending physician, explanations of the diabetic disease and their treatment were received by 90.38% and 66.35% of patients, respectively. However, these patients were aware of their disease and treatment in 18.27% and 41.35% of cases, respectively. The most observed non-adherence factors were the absence of an appointment given by the physician (30.77%), the feeling of well-being (24.04%), the lack of money (21.15%), forgetting (20.19%) and advice from a traditional practitioner (16.35%). Only the doctor's explanation for diabetes treatment was significantly associated with medication nonadherence (p=0.0310). Conclusion: Continuing medical education for physician is essential so that they can strengthen therapeutic education and follow-up for their diabetics.

Background: Insulin is classified as an "essential drug". It should be available in all pharmacies at an affordable price. This remains a major problem in low income countries like ours. Aim: Our study aims to describe the insulin availability and affordability in the Urban Municipality of Antananarivo, Madagascar. Methods: It was a cross sectional study over a period of 3 months at all pharmacies existing in the Urban Municipality of Antananarivo. Insulin availability was assessed according to the classification of the World Health Organization. Affordability was assessed from the ratio between the monthly cost of insulin treatment and the Malagasy monthly health expenditure, and the ratio between the monthly cost of insulin treatment and the guaranteed minimum inter-professional wage in Madagascar. Result: We had retained 79 pharmacies. Insulin availability in private pharmacies was higher than in public hospital pharmacies. Human insulin had a high availability rate: short-acting (70.89%) and mixed (78.08%). Availability of analogue insulin was low: fast-acting (7.59%) and long-acting (34.18%). To buy insulin, a patient was spending monthly 18.75 to 236.24% of the equivalent of guaranteed minimum inter-professional wage. All pharmacies had refrigerators to store insulin. Conclusion: The availability of insulin in the Urban Municipality of Antananarivo was high while diabetic patients have low financial affordability. A good governance health policy and multisectoral actions would be necessary.

Introduction This study aimed at determining the epidemiological‐clinical and paraclinical particularities of non‐ST‐segment elevation acute coronary syndrome (NSTE‐ACS) in Malagasy with type 2 diabetes mellitus (T2DM). Methods This was a retrospective, descriptive and comparative study between patients with and without T2DM, carried out over a period of 38 months. The diagnosis of NSTE‐ACS was retained in front of the association of chest discomfort, electrical abnormalities and elevations beyond fivefold the upper reference limit of high‐sensitivity cardiac troponin. Result With 130 patients included, the overall prevalence of NSTE‐ACS was 4.1%, of which 68 patients (52.3%) had T2DM. Compared to without T2DM, NSTE‐ACS in T2DM was characterized by young age (p = .0002), high‐frequency hypertension (OR 2.92 [1.23–7.25]; p = .0041), overweight/obesity (OR 4.39 [1.72–12.4]; p = .0002) and microalbuminuria (p < .0001), accelerated heart rate (p = .0104), atypical chest discomfort (OR 5.57 [2.21–15.7]; p < .0001), pulmonary crepitations (OR 2.25 [1.02–5.14]; p = .0224), high GRACE score (p = .0016), damage of extensive anterior leads (OR 2.11 [1.02–4.98]; p = .0402) and septal lead (OR 3.64 [1.41–10.3]; p = .0015), significant increase in cardiac troponin (p < .0001), high left ventricular filling pressure (OR 3.39 [1.51–7.90]; p = .001). Conclusion NSTE‐ACS in T2DM is frequent, with an atypical clinical and severe paraclinical presentations. Adequate and multidisciplinary management of cardiovascular risk factors, including T2DM, could thus minimize the occurrence of NSTE‐ACS and improve this profile.

Background: Diabetes mellitus is associated with severe and even fatal forms of COVID-19. The objective of this study was to identify the factors linked to the death of COVID-19 diabetic patients in order to improve their care.Methods: An analytical cross-sectional study was carried out in the endocrinology department of the Joseph Raseta Befelatanana University Hospital Center, Antananarivo, Madagascar. It has concerned all the cases of COVID-19 diabetics (162 patients) recorded from April 2020 to July 2021 (16 months).Results: In our study, the case fatality rate of COVID-19 in diabetics was 14.49%. Significant factors related to death, after univariate analysis, were:  vascular complications including nephropathy (OR=4.74), neuropathy  (OR=5.38) and ischemic heart disease (OR=3.9), presence of other comorbidities (OR=9.02), dyspnea (OR=4.60), seizures (OR=6.22) or alertness disorder (OR=4.35), lower oxygen saturation (p=0.04), pleurisy (OR=4.67), signs of cardiac decompensation (OR=3.46), an elevated mean blood sugar level (p<0.001), leukocytosis (p=0.02) and thrombocytopenia (p<0.001), impaired renal function (p=0.02) and pleurisy on chest imaging (OR=5.29).Conclusions: Death factors in diabetics with COVID-19 can be diverse. They do not only include the cardiovascular complications of the diabetes, but also a worse clinical respiratory presentation on the admission, a higher inflammatory syndrome, and a greater imbalance of blood sugar during the hospitalization.

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