title: Management of diabetes patients during the year prior to initiation of dialysis in France.
abstract: OBJECTIVE
  This study looked at the management of diabetes patients during the year prior to the initiation of dialysis.
  
  
  METHODS
  For this observational study, data were extracted from the National Health Insurance database for general-scheme beneficiaries (77% of the French population). Diabetes patients were identified by at least three reimbursements for antidiabetic drugs in 2012, while the initiation of dialysis was identified by specific refunds in 2013.
  
  
  RESULTS
  Of the 6412 patients initiating dialysis, 37% (n=2378) had diabetes (men: 61%, median age: 71 years, haemodialysis: 92%). Six months prior to dialysis, 68% had filled at least one prescription for insulin, 38% for other antidiabetics (25% glinides, 8% sulphonylureas, 8% metformin, 6% DPP-4 inhibitors), 69% for three or more classes of antihypertensive drugs and 55% for erythropoiesis-stimulating agents. Within 12 months to 1 month of dialysis, 81% were hospitalized, 28% with a main diagnosis of kidney disease. No nephrologist referral or hospitalization was identified at 6-0 months before dialysis in 6% of patients or in 24% at 12-7 months. One in five patients with diabetes consulted a private endocrinologist within 6 months of dialysis. An arteriovenous fistula was created 1 month before haemodialysis in 43% of patients.
  
  
  CONCLUSIONS
  The quality of preparation for dialysis was variable despite frequent hospitalizations. These data illustrate the need to mobilize patients with diabetes, and for healthcare professionals to more effectively anticipate and coordinate dialysis.
authors.affiliation: Caisse nationale de l'assurance maladie des travailleurs salariés, direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France. Electronic address: philippe.tuppin@cnamts.fr.
authors.forename: P
authors.initials: P
authors.lastname: Tuppin
authors.affiliation: Caisse nationale de l'assurance maladie des travailleurs salariés, direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France.
authors.forename: A
authors.initials: A
authors.lastname: Cuerq
authors.affiliation: Caisse nationale de l'assurance maladie des travailleurs salariés, direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France.
authors.forename: S
authors.initials: S
authors.lastname: Torre
authors.affiliation: Registre REIN, Agence de la biomédecine, 1, avenue du stade de France, 93212 Saint-Denis La Plaine cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Couchoud
authors.affiliation: Caisse nationale de l'assurance maladie des travailleurs salariés, direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France.
authors.forename: A
authors.initials: A
authors.lastname: Fagot-Campagna
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic; D008297:Male; D006435:Renal Dialysis
chemical_list: D007004:Hypoglycemic Agents
keywords: Diabetes; Dialysis; End-stage renal disease; Healthcare use; Observational study