Instauration d'une insulinothérapie chez le patient diabétique de type 2 en médecine générale : Comparaison de l'étude belge InsuStar avec quelques études françaises et internationales

Initiating insulin therapy is often considered as a challenge in general practice, thus leading to a delay in the shift to insulin. We compare the results of the observational prospective Belgian study InsuStar with those of several French and international studies. In most studies, initiating insulin therapy is proposed in patients with glycated hemoglobin (HbA1c) around 9% (75 mmol/mol). The initiation of insulin therapy, in most cases using basal insulin (NPH, or glargine), is associated with a mean HbA1c reduction of about 1.5%, but only around one third of the patients reach a target HbA1c level <7% (53 mmol/mol), which should promote further intensification of treatment. The risk of hypoglycemia is low, and patient's acceptance of insulin injection is usually good. These results should encourage general practitioners to initiate insulin therapy at an earlier stage in patients with insufficiently controlled type 2 diabetes on oral agents.