Huge progression of diabetes prevalence and incidence among dialysed patients in mainland France and overseas french territories. A second national survey six years apart. (UREMIDIAB 2 study)

in 1989, we conducted a survey (UREMIDIAB) on the prevalence of diabetes am ong the population on Renal Replacement Therapy (RRT) in Mainland France (M F), the lowest of the developed countries (6.9%) with a North-South gradien t (higher prevalence in the North). This highlighted a possible (genetical or nutritional) "new french paradox" in mainland France populations. In 199 2 we conducted a similar study in the french (mainly non caucasian) oversea s territories (OT) bosting 3.2% of the total french population, and observe d a prevalence of diabetes in RRT of 22.9%. The frequency of diabetes melli tus as a cause of ESRD increasing worldwide, we conducted a second survey i n year 1995, in MF and the OT. This study, UREMIDIAB 2, included all of the 244 french dialysis centers. A "Center file" allowed us to determine the p revalence and incidence of diabetes in the french RRT population, (response rate 73%). Then a "Patient medical file" (response rate 64.8% for MF and 9 1% for the OT) provided detailed informations: type of diabetes (type 1 or 2), etiology of nephropathy, status of diabetic complications, family's geo graphic origin of the patient. In MF the prevalence of diabetics in RRT dou bled within 6 years: 13.04% vs 6.9%, the incidence reached 15.7%. In the OT the prevalence and the incidence reached 25.7% and 35.6%, respectively. Ty pe 2 diabetes represented 87% end 93% of the RRT diabetics in MF and the OT , respectively. Diabetic nephropathy was considered as the cause of renal f ailure in 91.3% of type 1 a nd 57.5% of type 2 diabetics under dialysis. We found: 14.7% of myocardial infarction, 12.7% of cerebral strokes, 17.6% of amputations (extreme 37% in some OT centers) among this diabetic RRT popul ation. A North-East (higher preva- lence) South-West (lower) gradient was c onfirmed. We conclude that, while an unusual low prevalence (less than or e qual to 13%) of diabetics under dialysis persists in some parts of Mainland France, the total prevalence has been doubled within 6 years (1989/95) and that in Overseas Territories, hosting similar mixed blood populations than USA (afro-caribbeans, asians, indians, micronesians and metis), the high i ncidence of diabetes in RRT has reached the US levels during the same perio d.