Instauration de l’insulinothérapie chez les diabétiques de type 2 en France : données de l’étude INSTIGATE

Résultats 177 patients ont été recrutés en France (60,5% d’hommes, âge moyen de 64,7 ± 11,3 ans, ancienneté du diabète 12,7 ± 8,0 années en moyenne). Le taux moyen d’HbA 1c était de 9,5 ± 1,9% à l’instauration de l’insuline et de 7,7 ± 1,2% à 6 mois. Les doses moyennes d’insuline à l’initiation variaient de 17,1 UI (0,2 UI/kg) pour les insulines lente/intermédiaire à 51,6 UI (0,6 UI/kg) pour le schéma basal/bolus. Les coûts médians par patient dans les 6 mois précédant l’instauration de l’insuline et 6 mois après étaient respectivement de 647 € et 805 €. Conclusion L’instauration de l’insulinothérapie a permis une diminution du taux moyen d’HbA 1c à 6 mois, quel que soit le schéma initial de l’insulinothérapie prescrite. Toutefois, seuls 25% des patients avaient à 6 mois un taux d’HbA 1c < 7%, comme recommandé en France par la Haute Autorité de santé (HAS). Le coût médian de la prise en charge a augmenté après l’instauration de l’insuline, principalement du fait des coûts liés à l’insuline et à l’autosurveillance glycémique. Summary Aim To describe modalities of care and direct health costs associated with the first 6 months of insulin initiation of patients with type 2 diabetes initiating insulin as part of their usual care. The present article is focused on the characteristics of the French cohort. Methods The European observational study INSTIGATE (Insulin titration; gaining an understanding of the burden of type 2 diabetes in Europe) conducted in 2006–2007 with diabetologists and primary care physicians collected changes in antidiabetic and concomitant treatments, use of diabetes-related resources, clinical and laboratory results during the first 6 months of insulin treatment. Results In France, 177 patients were recruited as part of a European study. They had a mean age of 64.7 ± 11.3 years, 60.5% were male and the mean duration of diabetes was 12.7 ± 8.0 years. Mean HbA 1c was 9.5 ± 1.9% at insulin initiation and 7.7 ± 1.2% at 6 months. Mean insulin doses at treatment initiation ranged from 17.1 IU (0.2 IU/kg) for long/intermediate-acting insulin to 51.6 IU (0.6 IU/kg) for basal/bolus regimen. Median total costs for the 6 months prior to insulin initiation and the first 6 months of insulin therapy were 647 and 805 €, respectively. Conclusion The mean HbA 1c decreased after 6 months of insulin treatment, regardless of modalities of insulin regimen at initiation. However, at 6 months only 25% of patients had an HbA 1c <7% as required by the French High Authority for health. The median cost of diabetes care increased following insulin initiation, mainly due to an increase in costs for insulin and for blood glucose monitoring. 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