Management of diabetes in French prisons: a cross-sectional study

Aims To assess by a survey the management of prisoners with diabetes treate d with insulin in French prisons. Methods A questionnaire was sent to the head of healthcare services for pri soners of every French prison. Information was obtained on prevalence of in sulin-treated diabetes prisoners and diabetes care in prison. The number of episides of ketoacidosis and hypoglycaemia needing hospital admissions wer e evaluated during the past year. Results Among the 163 questionnaires sent, 115 were returned, giving an ove rall response rate of 69%. At the time of the study the prison population w as 38 175 people. One hundred and sixty-nine prisoners were treated by insu lin (0.4%). Self-monitoring of blood glucose was available only for 94 (55. 6%) insulin-treated prisoners. A total of 130 (76.9%) prisoners performed t wo insulin injections daily or less, 105 (62.1%) prisoners were not allowed to keep their insulin delivery systems with them. Of the prisoners who tre ated themselves, 14 (12.1%) used syringes and 42 (36.5%) used pen devices. Ninety-two (55.1%) prisoners had had access to a diabetes specialist during the previous year. Diabetic diets were available in only 65 (60.7%) prison s. From June 1998 to June 1999, there were 20 hospital admissions for a dia betic ketoacidosis and 14 for hypoglycaemia. Conclusions This study shows that prison decreases the autonomy of diabetic prisoners who often cannot self-inject or test their blood. Access to visi ting consultant diabetologists and specialist nurses to educate both prison ers with diabetes and prison staff could improve diabetic care.