Diabetes mellitus is a disease with significant public health implications, given its rising prevalence, the number of undiagnosed cases, the resulting decline in quality of life, and the complications associated with it… For Santé publique France, the challenge is therefore to ensure its epidemiological surveillance and to contribute to the prevention of type 2 diabetes.

Epidemiological Surveillance of Diabetes

In 2001, Santé publique France developed an epidemiological surveillance program for diabetes. The program is part of the Cardio-Metabolic Unit. This program aims to provide indicators of the prevalence, severity, and trends of diabetes, specifically regarding:

• prevalence, incidence, mortality, and trends in adult diabetes

• characteristics (particularly socioeconomic), vascular risk, and complications of diabetes in adults

• quality of life among adults with diabetes.

To develop this program, Santé Publique France launched the three Entred studies in 2001, 2007, and 2019. These studies provide a wealth of information useful for diabetes surveillance.
The third edition of this study was launched in 2019, involving 13,000 people with diabetes in mainland France and the overseas departments.
This national study on diabetes aims to better understand the needs and care of people with diabetes in France. In particular, it collects information on health status, socioeconomic status, quality of care (including educational initiatives), the care pathway, quality of life for people with diabetes, treatment strategies, the cost of care, and levers for improving medical practices.

Other studies and national data contribute to this surveillance program, notably the Santé publique France Barometer, which has made it possible to estimate the prevalence of diagnosed diabetes, including the proportion managed exclusively through lifestyle and dietary interventions.

• Diabetes: Prevalence and the Role of Lifestyle and Dietary Measures in Its Treatment. Overview of the Initial Results of the 2024 Santé publique France Barometer

In addition, studies involving health examinations allow for the estimation of the prevalence of undiagnosed diabetes. Thus, the ENNS 2006–2007 study made it possible to estimate the prevalence of undiagnosed diabetes and the prevalence of diabetes treated through lifestyle and dietary measures for the first time.

As for the Esteban study, it updated these prevalence estimates. This national study, conducted in metropolitan France among adults aged 18 to 74, examined several aspects of health: exposure to certain environmental substances, diet, physical activity, and certain chronic diseases or risk factors (diabetes, allergies, respiratory diseases, high blood pressure, high cholesterol, etc.).
The Constances cohort, consisting of a sample of 200,000 people aged 18 to 69, also makes it possible to estimate these prevalence rates and break them down by socioeconomic status. The ongoing Albane study will update these estimates.

This diabetes surveillance program also relies on data from the National Health Data System (SNDS). These data enable the estimation of the prevalence of pharmacologically treated diabetes and the incidence of complications (myocardial infarction, stroke, lower limb amputation, end-stage chronic kidney disease).

In addition, Santé publique France has established a specific surveillance system for gestational and pre-gestational diabetes. This project is jointly led by the perinatal surveillance program and the diabetes surveillance program. In this context, indicators for monitoring diabetes in pregnant women and its fetal and maternal complications and comorbidities are being developed using medical and administrative databases from the National Health Data System (SNDS).

Santé publique France also monitors the links between type 1 diabetes and environmental exposures, particularly air pollution and endocrine disruptors.

Prevention measures against type 2 diabetes

Santé Publique France provides information and recommends appropriate preventive measures, such as lifestyle and dietary changes to reduce the risk of type 2 diabetes.

Santé Publique France participates in the “Say No to Diabetes” campaign.
Indeed, the Ministry of Solidarity and Health, the National Health Insurance, and the regional health agencies of the three affected territories (Bas-Rhin, Seine-Saint-Denis, Réunion), in partnership with the French Diabetes Federation, the Francophone Diabetes Society, and the College of General Medicine, and Santé publique France are launching a large-scale pilot program in France for an intensive diabetes prevention program focused on three areas: diet, physical activity, and psychosocial support for change through group sessions.
The goal is to support people at high risk of developing diabetes in changing their eating habits and increasing their physical activity, in order to delay or prevent the disease.

Learn more: Say No to Diabetes

- Information for the general public

Santé Publique France provides the general public with several websites outlining the dietary and lifestyle guidelines to follow to prevent type 2 diabetes. These sites promote a varied and balanced diet, regular physical activity, reducing sedentary behavior, as well as limiting alcohol consumption and quitting smoking.

• http://www.mangerbouger.fr

• http://www.alcool-info-service.fr/

• https://www.tabac-info-service.fr/

- Information for healthcare professionals

To support healthcare professionals in preventing type 2 diabetes, dedicated sections are available on various websites created by Santé publique France:

• mangerbouger.fr: professional section

• alcool-info-service.fr: professional section

In addition, the HAS provides a guide on type 2 diabetes in adults.

- Support for people with diabetes

To support people with type 1 or type 2 diabetes, Ameli provides “Sophia et vous” newsletters available on their website.
As part of efforts to support people at high risk of developing diabetes, tools are offered on the “Dites non au diabète” website