title: Type 2 diabetes treatment intensification in general practice in France in 2008-2009: the DIAttitude Study.
abstract: OBJECTIVE
  To evaluate the current procedures in French general practice of intensifying hypoglycaemic treatment in orally treated type 2 diabetic patients, according to the French recommendations.
  
  
  METHODS
  Type 2 diabetic patient characteristics, HbA(1c) values, hypoglycaemic treatment and physician characteristics were collected from the electronic records of a panel of French general practitioners. Factors associated with the time until intensification of treatment were studied with the Cox model.
  
  
  RESULTS
  Among 17 493 orally treated patients with at least two available HbA(1c) values, 3118 patients (18%) required treatment intensification; 65% were on monotherapy, 31% on bitherapy and 4% on tritherapy. These patients were followed for a maximum of 14 months or until treatment was intensified. Treatment was intensified after the second high HbA(1c) value for 1212 patients (39%); this was immediate for 13% of these patients, within 6 months for 39% and within one year for 59%. Treatment intensification was less likely the older the patient, and more likely the higher the first HbA(1c) value, up to an HbA(1c) threshold of 9%.
  
  
  CONCLUSIONS
  Therapeutic inertia in caring for type 2 diabetic patients in France is frequent, at least for patients treated in general practice. This inadequate glycaemic control would be expected to have significant patient and public health consequences, with higher rates of associated diabetic complications.
authors.affiliation: Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Epidemiology of Diabetes, Obesity and Chronic Kidney Disease Over the Lifecourse and Determinants of Early Nutrition, Villejuif, France. beverley.balkau@inserm.fr
authors.forename: B
authors.initials: B
authors.lastname: Balkau
authors.forename: S
authors.initials: S
authors.lastname: Bouée
authors.forename: A
authors.initials: A
authors.lastname: Avignon
authors.forename: B
authors.initials: B
authors.lastname: Vergès
authors.forename: I
authors.initials: I
authors.lastname: Chartier
authors.forename: E
authors.initials: E
authors.lastname: Amelineau
authors.forename: S
authors.initials: S
authors.lastname: Halimi
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D004334:Drug Administration Schedule; D005260:Female; D005602:France / Q000453:epidemiology; D058006:General Practice / Q000592:standards / Q000706:statistics & numerical data; D006442:Glycated Hemoglobin / Q000378:metabolism; D019983:Guideline Adherence; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human