Perspectives pour améliorer la prise en charge des patients diabétiques de type 2 sous insuline

Insulin is a crucial and effective treatment in some type 2 diabetes (T2DM) patients. In France approximately 20% of T2DM patients are treated with insulin; currently, 40% of T2DM are transferred to insulin by their GP. Worldwide, insulin is feared by patients and often delayed by doctors, initiation is done at around 9% HbA1c. Once it is started and used, many observational studies reveal that this use is not optimal, poor knowledge on the disease and of objectives, insufficient control of technical gestures, slow titration, and consequently insufficient improvement of blood glucose in too many patients. Fear of hypoglycemia also represent an obstacle for patients and caregivers limiting the achievement of objectives. Insulin treatment is often lacking, educational support scarce as is care coordination. The cost of insulin treatment for T2DM is very important, expenditure for insulin and SMBG, but even more of hospitalizations and especially of injection by private nurses. Possible solutions: serious training of doctors and nurses (desirable nurse degree specialized in diabetes), definition of diabetologist role, cooperation care and pathway organization, ASALEE program, other interprofessional cooperation protocols, more educational offer. The arrival on the market of new basal insulins, safer with less hypoglycemic events may reduce them. Adapted educational approaches to culture, age, socioeconomic levels (participation of entourage, peer coaching) and new technologies (Smartphones, Internet, telephone coaching, etc.) also offer significant room for improvement.