[Current management of type 2 diabetes in France].

Many data are available on the epidemiology of type 2 diabetes in France (ENTRED 2007, DIABASIS 2008). It is currently estimated that 2.2 million people (3.8% of the population) have type 2 diabetes, with a higher prevalence among those with lower socioeconomic status. Ninety-five per cent of patients are over 45 years of age, 52% are male, 71% are overweight, 54% have hypertension, 18% have elevated LDL cholesterol, 19% have elevated triglyceride levels, and 13% are smokers. The main complications are cardiac (16.7%), retinal (16.6%), and renal disorders (elevated plasma creatinine in 19%), and foot ulcers (9.9%). HbA1c values exceed 7% in 41% of cases. Most patients are treated by general practitioners (93%), while 20% are followed by a diabetologist. Education is provided more often by hospital diabetologists (71%) than by general practitioners (11%). Nine out of ten patients are treated with oral antidiabetic drugs, consisting of metformin (62%), sulfonylurea (50%), glitazones (13%), glinides (8%), and alpha glucosidase inhibitors (8%), usually alone (43%) or in dual-agent combinations (29%). Insulin is prescribed to 17% of patients, an average of 13.8 years after initial diagnosis. Three-quarters of patients are prescribed antihypertensives, 47% statins and 40% antiplatelet drugs. One-third of patients are poorly adherent to their treatment and three-quarters experience adverse effects. Only one-quarter of patients follow dietary measures. The estimated annual per-patient cost of type 2 diabetes is 5400 euros, a sum that is fully reimbursed in 89% of cases. Patient management in France started to improve markedly in 2001 (ENTRED 2001), with more attention being paid to risk factors, and more widespread use of antihypertensive drugs, statins and antiplatelet agents. If the dramatic increase in the incidence of type 2 diabetes is to be reversed, patients at risk must be identified and managed earlier. In particular, plasma glucose levels must be determined regularly in all people over 45 years of age and in all subjects at risk of diabetes. Management of hyperglycemia and other risk factors must be more aggressive and adapted to disease progression. Patient follow-up must be improved, taking in account the entire healthcare infrastructure, and especially structures involved in the treatment of obesity and diabetes.