CA-123: L'insulinothérapie chez le diabétique type 2 : en ambulatoire ou en hospitalisation ?

Persistently High Glycated Hemoglobin in a Subgroup of Type 2 Diabetic Patients Who Failed Usual Oral Antihyperglycemics and Insulin in Côte d’Ivoire

“…These results are consistent with La-Salle and Berria, who estimated that 50% of patients begin insulin therapy within 5 years after failing to achieve or maintain glycemic control despite taking several oral antidiabetics [12]. The average HbA1c at the start of insulin therapy was 11.4%, unlike Home et al, who found an average HBA1c of 9.5% [13]. This difference shows that the start of insulin treatment occurred late in this present cohort.…”

“…In this study, the average duration of initiation of insulin treatment of 5 years is a sufficiently long period to judge the effectiveness of insulin treatment on glycemic control. This duration agrees with the Cardiovascular risk evaluation in people with type 2 diabetes on insulin therapy (CREDIT) study in which the treatment initiation lasted 4 years to assess glycemic control and help in treatment planning [13].…”

“…The mean daily insulin dose is 0.9 ± 0.21 IU/kg/d higher than the 0.5 ± IU/Kg/d and 0.66 IU/Kg/d observed by Home and Grira, respectively [13] [14]. Despite the 0.9 IU/Kg/d dose at the start of insulin, almost 46% of the patients had proven exogenous insulin resistance, and there was no significant drop in HbA1c (p = 0.1), unlike in Grira's work, which revealed a drop in HbA1c from 11.2% at the start to 8.7% at the end of the study.…”

“…In fact, the duration of insulin therapy initiation makes it possible to generally assess the progress of insulin treatment in type 2 diabetics and its impact on glycemia. It also leads to assessing the time taken by the patient to achieve glycemic control [13].…”

“…This difference is explained by the fact that the "basal bolus" regimen, the most physiological insulin regimen, lowers blood sugar better than the premix regimen [18]. In fact, insulin therapy regimens make it possible to assess the performance of different insulin types according to patient profiles and their effect on glycemia [13].…”