Precariousness, Diabetes Control and Complications in French Guiana

Abstract

AimsThe social parameters of an individual impact the incidence of cardiovascular diseases. French Guiana, an overseas French territory with a lower standard of living than France, has a prevalence of diabetes mellitus that is twice that of mainland France. In this context we aimed to study the relation between precariousness, diabetes complications and glycemic control.MethodsA multicenter prospective cohort was initiated since May 2019. 1243 patients were included and their outcomes and history were compared between the precarious and non-precarious based on their EPICES score, a score that measures social isolation and precariousness.Results73.3% of the sample was considered precarious. Retinopathy was significantly more frequent among the deprived. There were no significant differences for other macro or microvascular complications.There was a significant difference in Glycated Haemoglobin between the precarious and non-precarious groups (8.3% (67 mmol/l) vs 8.8% (73mmol/l)). After adjusting for potential confounders, precariousness was no longer associated with poor glycemic control; the independent factors significantly associated with poor glycemic control were: not being fluent in French, having creole or portugese as mother language, and not having any insurance.ConclusionsPrecariousness is a risk factor for retinal complications in patients with diabetes mellitus in French Guiana. In this chronic disease, the universal healthcare system alleviates health inequalities for many, but not all, diabetic complications.Translation and cultural mediation may further reduce health inequalities in this multicultural territory where a substantial proportion of the population is not fluent in French.

Contrasted life trajectories: reconstituting the main population exposomes in French Guiana

“…Perhaps an exception concerns deliveries in western French Guiana, where women from Suriname cross over to deliver in the maternity ward of Saint Laurent du Maroni hospital. Although foreigners may sometimes suffer from discrimination ( 59 , 60 ), they also benefit from extra efforts to correct social inequalities in health ( 52 , 61 , 62 ). However, because they do not know their rights or because complex administrative requirements discourage them from pursuing them, immigrants often do not apply for social benefits that they would be entitled to, thus contradicting common preconceptions.…”

“…As a general rule of thumb, for infectious, chronic, obstetrical, or nutritional diseases, immigrants tend to have more advanced pathologies, which occur at younger ages ( 60 , 64–69 ). However, for prolonged diseases, once immigrants benefit from health insurance, the differences between foreign and French or between precarious and non-precarious persons tend to disappear because the health system strives to compensate for their vulnerabilities by enhancing therapeutic education, health mediation and translation services, nurse visits at home ( 62 ), and an increased tendency to hospitalize patients living in difficult conditions ( 61 ). A complementary explanation is that, with time, immigrants develop social capital and expertise in the health system.…”

Complex Sex Differences in Life Expectancy in French Guiana

“…The complex picture that emerges from these data has different layers: first, when comparing with mainland France, life expectancy at birth in French Guiana was significantly shorter both in males and females; unsurprisingly, the standardized death rate of males in French Guiana was substantially greater than that of women, and their life expectancy at birth was significantly shorter. Life expectancy at 20 years, which allows to remove the effect of the greater child mortality in French Guiana [ 17 ], was also shorter in French Guiana for males and females, perhaps reflecting the burden of external causes (accidents, homicides, drowning…) and AIDS in males and perhaps metabolic diseases in women—mostly diabetes. More surprisingly, the differences between mainland France and French Guiana regarding life expectancy at 40 and 60 years was mainly found among females, while males in French Guiana had a slightly lower or similar life expectancy at 40 and 60 years than in mainland France.…”

Impact of Lipoprotein(a) on Macrovascular Complications of Diabetes in a Multiethnic Population in the French Amazon

“…Diabetes was defined as an increase in fasting plasma blood glucose greater than or equal to 126 mg/dL (or 7 mmol/L) on two occasions and/or a blood glucose level taken at any time of the day greater than or equal to 200 mg/dL (or 11 mmol/L) on two occasions. We followed the methods of Linière et al [15].…”