Le diabète de type 2 en France : épidémiologie, évolution de la qualité de la prise en charge, poids social et économique. Entred 2007

Druet, C.; Bourdel-Marchasson, I.; Weill, Alain; Eschwège, É.; Penfornis, A.; Fosse, S.; Fournier, Cécile; Chantry, M.; Attali, Claude; Lecomte, P.; Simon, Dominique; Poutignat, N.; Gautier, Arnaud; Risse, Mathilde; Fagot-Campagna, A.

doi:10.1016/j.lpm.2013.02.312

Cited by 21 publications

(28 citation statements)

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“…To assess the representativeness of our OREDIA population, it was of interest to compare our patients without CKD to the general diabetic population of the French ENTRED 2007 survey8,21 even though the diabetic population of ENTRED included a significant proportion of patients with CKD (about 30%). Patient characteristics were fairly similar in many aspects: ENTRED participants had a mean age of 66 years (versus 63 years in non-CKD patients of OREDIA), and the mean duration of diabetes (9 years), mean BMI (29 kg/m 2 ), and mean glycemic control (HbA 1c of 7.1%) were identical in ENTRED and OREDIA.…”

Section: Discussionmentioning

confidence: 99%

How are patients with type 2 diabetes and renal disease monitored and managed? Insights from the observational OREDIA study

Penfornis¹,

Blicklé²,

Fiquet³

et al. 2014

VHRM

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Background and aimChronic kidney disease (CKD) is frequent in type 2 diabetes mellitus (T2DM), and therapeutic management of diabetes is more challenging in patients with renal impairment (RI). The place of metformin is of particular interest since most scientific societies now recommend using half the dosage in moderate RI and abstaining from use in severe RI, while the classic contraindication with RI has not been removed from the label. This study aimed to assess the therapeutic management, in particular the use of metformin, of T2DM patients with CKD in real life.MethodsThis was a French cross-sectional observational study: 3,704 patients with T2DM diagnosed for over 1 year and pharmacologically treated were recruited in two cohorts (two-thirds were considered to have renal disease [CKD patients] and one-third were not [non-CKD patients]) by 968 physicians (81% general practitioners) in 2012.ResultsCKD versus non-CKD patients were significantly older with longer diabetes history, more diabetic complications, and less strict glycemic control (mean glycated hemoglobin [HbA1c] 7.5% versus 7.1%; 25% of CKD patients had HbA1c ≥8% versus 15% of non-CKD patients). Fifteen percent of CKD patients had severe RI, and 66% moderate RI. Therapeutic management of T2DM was clearly distinct in CKD, with less use of metformin (62% versus 86%) but at similar mean daily doses (~2 g/d). Of patients with severe RI, 33% were still treated with metformin, at similar doses. For other oral anti-diabetics, a distinct pattern of use was seen across renal function (RF): use of sulfonylureas (32%, 31%, and 20% in normal RF, moderate RI, and severe RI, respectively) and DPP4-i (dipeptidyl peptidase-4 inhibitors) (41%, 36%, and 25%, respectively) decreased with RF, while that of glinides increased (8%, 14%, and 18%, respectively). CKD patients were more frequently treated with insulin (40% versus 16% of non-CKD patients), and use of insulin increased with deterioration of RF (19%, 39%, and 61% of patients with normal RF, moderate RI, and severe RI, respectively). Treatment was modified at the end of the study-visit in 34% of CKD patients, primarily to stop or reduce metformin. However, metformin was stopped in only 40% of the severe RI patients.ConclusionDespite a fairly good detection of CKD in patients with T2DM, RI was insufficiently taken into account for adjusting anti-diabetic treatment.

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Section: Discussionmentioning

confidence: 99%

How are patients with type 2 diabetes and renal disease monitored and managed? Insights from the observational OREDIA study

Penfornis¹,

Blicklé²,

Fiquet³

et al. 2014

VHRM

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“…To assess the representativeness of the VILDA population, it is of interest to compare the patients with the national sample (2007 “Échantillon National Témoin REprésentatif des personnes Diabétiques” (ENTRED) survey: conducted to monitor the health status of adult diabetic patients from a representative sample of French diabetic patients pharmacologically treated [34]), even if the T2DM patients included in VILDA study were inherently different in that they were seen at the time of treatment intensification. VILDA participants were slightly younger (63 years vs. 66 years in ENTRED), predominantly male (60% vs. 53%), and their diabetes was more recent (mean duration from diagnosis of 7 vs. 9 years).…”

Section: Discussionmentioning

confidence: 99%

Use of Vildagliptin in Management of Type 2 Diabetes: Effectiveness, Treatment Persistence and Safety from the 2-Year Real-Life VILDA Study

et al. 2014

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IntroductionThere is an increasing interest for real-life data on drug use in many countries. Reimbursement authorities more and more request observational studies to assess the conditions of use of the products but also to improve knowledge about efficacy and safety in the real world and on a longer term than in clinical trials.AimTo evaluate the effectiveness, treatment persistence and tolerability of vildagliptin in clinical practice.MethodsThis observational, 2-year prospective cohort study was conducted in France on request of the Health Authorities [Haute Autorite de Sante (HAS)]. Type 2 diabetic mellitus (T2DM) patients initiating vildagliptin (including the fixed combination vildagliptin-metformin) or treated for <6 months were recruited through a national representative sample of general practitioners (GPs) (n = 482) and diabetologists (n = 84) between March 2010 and December 2011. At inclusion and each follow-up visit at ~ 6, 12, 18 and 24 months, a questionnaire was completed by the physician collecting information on socio-demographic, clinical and biological data, treatments and adverse events.Results1,700 patients were included: 60% were males, aged 63 ± 11 years, with diabetes duration 7 ± 6 years and body mass index (BMI) 30 ± 6 kg/m2. 45% were obese, 70% treated for hypertension and 66% for dyslipidemia. 64% of the patients received vildagliptin in dual therapy with metformin. 82% of patients completed the 2-year follow-up. Glycosylated hemoglobin (HbA1c) decreased from a mean baseline of 7.8 ± 1.2% when vildagliptin was started, to 7.0 ± 1.1% at 6 months and remained stable thereafter over 2 years. Mean weight, glomerular filtration rate, liver enzymes, and lipid parameters were unchanged over the study period. Eight patients (0.5%), all concomitantly treated with insulin and/or sulphonylureas, reported one severe hypoglycemia and 47 (2.9%) patients reported 64 non-severe symptomatic hypoglycemia (59% occurred when patients were treated with insulin and/or sulphonylureas). At 6 months, 44.9% of vildagliptin-treated patients reached an HbA1c <7% without hypoglycemia and no weight gain, and this percentage increased to 49.7% at 24 months. Vildagliptin treatment maintenance at 2 years was 88.8% [95% CI (87.2%; 90.4%)], with 4% of patients discontinuing for adverse events.ConclusionsIn everyday conditions of care, vildagliptin efficacy was in line with existing data from randomized clinical trials, sustained over 2 years, with low discontinuation rate and low hypoglycemia risk.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-014-0064-0) contains supplementary material, which is available to authorized users.

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“…Nine studies report costs for type 2 diabetes patients in France (49,51,(58)(59)(60)(61)(62)(63)(64). They report on annual overall healthcare costs as well as on speci c costs for diabetes treatment and associated costs (for detailed results see tables 21-29, additional material).…”

Section: Diabetes Costs In Francementioning

confidence: 99%

“…No study assessed indirect costs. Seven studies based their analysis on the same data base: L'Échantillon Généraliste de Béné ciaires (58)(59)(60)(61)(62)(63)(64).…”

Section: Diabetes Costs In Francementioning

confidence: 99%

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Costs and Its Drivers for Diabetes Mellitus Type 2 Patients in France and Germany: A Systematic Review of Economic Studies

Stegbauer¹,

Falivena

Moreno

et al. 2020

Preprint

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Background Type 2 diabetes represents an increasingly critical challenge for health policy worldwide. It absorbs massive resources for both patients and national economies to sustain direct and associated costs of treatment and indirect costs related to loss of work and wages. Last years are fuelling of innovations grounded on the remote control and personalised programs which are significantly improving the management of diabetes and the reduction of its related complications. In this view, this work attempts to update cost analysis reviews on type 2 diabetes, focusing on France and Germany, in order to explore most significant cost drivers and rooms for cost savings by technology advancement. Although characterized by different approaches in delivering care, France and Germany represent the primary European markets for diabetes technologies. Methods A systematic review of the literature was carried out in MEDLINE, Embase and EconLit for interventional, observational, and modelling studies on expenditures for type 2 diabetes management in France or Germany published since 2012. Included articles were analysed for annual direct, associated, and indirect costs of type 2 diabetes patients. An appraisal of study quality was performed. Results are summarised narratively. Results From 1.260 records, the final sample was composed of 24 papers selected according to predefined inclusion/exclusion criteria. Both France and Germany revealed a predominant focus on direct cost. Comparability was limited due to different study populations and cost categories used. Nevertheless, France seems to reimburse higher direct costs than Germany. Indirect costs were only available for Germany. According to prior literature, reported cost drivers are hospitalisation and prescriptions as well as higher HbA1c and BMI, treatment with insulin and complications all indicating the severity of the disease. Diversity in available data and in included costs limit the results and may explain differences found. Conclusions Preventing complications and glycaemic control are widely recognized as the most effective ways to govern the expenditure for the treatment of diabetes. The implementation of self-based supports, such as hybrid closed-loop metabolic, already implemented for type 1 diabetes management, are the key pillars for further debates and policymaking, involving the perspectives of both caregivers and patients.

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Le diabète de type 2 en France : épidémiologie, évolution de la qualité de la prise en charge, poids social et économique. Entred 2007

Cited by 21 publications

References 1 publication

How are patients with type 2 diabetes and renal disease monitored and managed? Insights from the observational OREDIA study

How are patients with type 2 diabetes and renal disease monitored and managed? Insights from the observational OREDIA study

Use of Vildagliptin in Management of Type 2 Diabetes: Effectiveness, Treatment Persistence and Safety from the 2-Year Real-Life VILDA Study

Costs and Its Drivers for Diabetes Mellitus Type 2 Patients in France and Germany: A Systematic Review of Economic Studies

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