title: Current insulin therapy in patients with type 2 diabetes: results of the ADHOC survey in France.
abstract: OBJECTIVE
  In France, the Afssaps/HAS 2006 guidelines for insulin-treated type 2 diabetic patients recommend a target glycated haemoglobin level (HbA(1c)) of less than 7%, achieved by optimalizing the insulin dose or increasing the number of daily injections. The present study investigated to what extent these recommendations are followed in clinical practice by general practitioners (GPs) and diabetologists (DTs).
  
  
  METHODS
  The ADHOC study (observational, transversal) was a survey of 267 GPs and 180 DTs prescribing insulin in France (participation rate: 4.45% and 11.6% of GPs and DTs, respectively). Physicians answered a questionnaire focused on aspects of insulin therapy in type 2 diabetic patients receiving oral antidiabetic drugs (OADs) and insulin for at least six months.
  
  
  RESULTS
  A total of 1874 patients were included in the study (959 from GPs and 915 from DTs). Insulin was initiated about 10 years after the diagnosis of diabetes, when patients had high HbA(1c) levels (mean value: 9.2%). At the time of the survey, patients had been treated with insulin for 3.4 ± 3.5 years (mean ± SD), and the mean HbA(1c) was significantly reduced (P<0.05) to 7.8% and 7.9% in patients treated by GPs and DTs, respectively. However, almost 80% of patients had HbA(1c) levels greater than 7%, and 35% had levels greater than 8%. The last fasting blood glucose level was 144 ± 45 mg/dL. More than 60% of patients with HbA(1c) greater than 8% were using single daily injection therapy. On consultation day, insulin treatment (dose, number of injections and type of insulin) was not optimalized in more than 40% of the latter patients. Differences in data between patients treated by GPs and DTs were small and often not statistically significant.
  
  
  CONCLUSIONS
  In this study, the main therapeutic goals of insulin therapy, as defined by the Afssaps/HAS 2006 guidelines, were only attained in around 20% of type 2 diabetic patients, irrespective of follow-up by a GP or DT. During consultation, insulin therapy was not optimalized in a large proportion of inadequately controlled patients.
authors.affiliation: Department of Endocrinology-Metabolism and Diabetology-Nutrition, University Hospital of Besançon, EA 3920, University Franche-Comté, 25000 Besançon, France. alfred.penfornis@univ-fcomte.fr
authors.forename: A
authors.initials: A
authors.lastname: Penfornis
authors.forename: F
authors.initials: F
authors.lastname: San-Galli
authors.forename: L
authors.initials: L
authors.lastname: Cimino
authors.forename: D
authors.initials: D
authors.lastname: Huet
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism; D005602:France; D058006:General Practice / Q000379:methods*; D006442:Glycated Hemoglobin / Q000378:metabolism; D019538:Health Care Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D008511:Medicine / Q000379:methods*; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human