In 2007, a study commissioned by the French Institute for Public Health Surveillance (InVS) and conducted by the French National Institute of Health and Medical Research (Inserm) concluded that there was a need for more information regarding the quality of diabetes care and the care pathway for children with diabetes in France (report on the epidemiological surveillance of childhood diabetes). When the Entred study on adults was renewed in 2007, an additional sample of children with diabetes under the age of 18 was selected for the first time.

The objectives of the Entred-Enfant survey are to:

• ·describe the modalities of medical care and the quality of this care for children with diabetes under the age of 18 based on medical utilization data and the PMSI;

• develop an algorithm for classifying diabetes in children (type 1, type 2, MODY, cystic fibrosis) based on medical utilization data;

• to provide a database of adolescents with diabetes aged 11 to 17 who consent to having their contact information shared with Inserm for a study covered by a specific protocol. Among its specific objectives, Entred-Ado aims to study the health status of adolescents with diabetes, the impact of diabetes on their integration into school, society, and family life, as well as to test the diabetes classification algorithm and the medical care protocols defined in medical-administrative databases.

Individuals selected for Entred-Enfant

For Entred-Enfant, the Health Insurance Agency randomly selected all individuals:

• under the age of 18;

• residing in mainland France or overseas territories;

• insured or beneficiaries of the National Health Insurance Fund for Salaried Workers (CnamTS) or the Social Security Scheme for the Self-Employed (RSI);

• who have received at least three reimbursements for oral antidiabetic medications and/or insulin over the past 12 months.

The random selection was based on registration codes (the last two digits of the Social Security number). All children with diabetes from 6 different registration codes were selected to ensure a sufficient sample of children and adolescents (approximately 900 children expected, including 600 adolescents).

A total of 924 children were included, including 624 adolescents (ages 11–17).

Data from the Entred-Enfant study

Data on reimbursements for medications, medical services (consultations, laboratory tests), medical supplies, and hospitalizations for children and adolescents with diabetes were extracted from the Health Insurance and PMSI databases over a 3-year period and analyzed anonymously by the InVS.

Entred-Ado, a specific survey of adolescents conducted in 2008–2009

A survey was conducted via telephone questionnaire among 624 adolescents aged 11 to 17 as of August 1, 2007, who were selected for Entred-Enfant. This specific study, called Entred-Ado, conducted starting in September 2008 by the French National Institute of Health and Medical Research (Inserm), was subject to a specific agreement with the French Data Protection Authority (CNIL).