The medical and therapeutic management of people with diabetes is primarily examined based on the Entred studies, conducted in 2001 and 2007. Antidiabetic treatments intensified between 2001 and 2007, and treatment choices changed to better align with current recommendations. However, glycemic control remains inadequate for 41% of people with type 2 diabetes (HbA1c > 7%), exposing them to the risk of complications affecting the kidneys, eyes, nerves, and blood vessels. The currently recommended treatment escalation—involving the addition of one, then two, then three oral antidiabetic medications, followed by insulin if glycemic control remains inadequate—is therefore still not fully adhered to. Preventive treatments for cardiovascular and renal diseases have also been significantly intensified, resulting in a substantial decrease in blood pressure and cholesterol levels between 2001 and 2007. Here too, improvements remain possible, particularly regarding blood pressure control, since 49% of people with type 2 diabetes have blood pressure that strictly exceeds the recommended threshold of 130/80 mmHg. Significant improvements in the quality of medical care have been observed, with the procedures necessary for screening and monitoring diabetes complications being performed more frequently. However, fundus examinations—necessary for screening for retinopathy—and urine albumin testing—necessary for screening for early kidney damage—are still performed too infrequently and have seen little progress. Thorough foot examinations, which aim to screen for neuropathy and peripheral vascular disease and to treat any lesions early, are performed far too infrequently. General practitioners manage 87% of these patients on their own, without consulting a diabetes specialist. General practitioners are therefore key players in the progress made and that which remains to be done, serving as coordinators of the care pathway between healthcare professionals and diabetes specialists.

Learn more:

• Fagot-Campagna A, Dossou Y, Fournier C, Penfornis A, Cabanel-Gicquel MC, Poutignat N, Gautier A, Weill A, Druet C. Epidemiology of type 1 diabetes. La revue du praticien en médecine générale 2011 (June), 862 (25).

• Robert J, Roudier C, Poutignat N, Fagot-Campagna A, Weill A, Rudnichi A, Thammavong N, Fontbonne A, Detournay B, on behalf of the Entred Scientific Committee. Care of people with type 2 diabetes in France in 2007 and trends compared to 2001. Bull Epidemiol Hebd 2009,42-43:455-60

• Slide show "Characteristics of people with diabetes, vascular risk, complications, and medical care" from the 2007 Entred study. [ppt - 188 KB]

• Commented slideshow on the therapeutic management of people with diabetes based on data from Entred 2001. [ppt - 188 KB]

• Slide show with commentary on the therapeutic management of vascular risk in people with type 2 diabetes based on data from Entred 2001. [ppt - 767 KB]

• Slide show with commentary on the therapeutic management of vascular risk in people with type 1 diabetes, based on data from Entred 2001. [ppt - 312 KB]

• Fagot-Campagna A, Simon D, Varroud-Vial M, Ihaddadène K, Vallier N, Scaturro S, Eschwège E, Weill A, on behalf of the Entred Scientific Committee. Characteristics of treated diabetic patients and the alignment of medical follow-up for diabetes with official recommendations. Entred 2001. Bull Epidemiol Hebd 2003,49-50:238-9.

• Livinec F, Weill A, Varroud-Vial M, Simon D, Vallier N, Isnard H, Fagot-Campagna A, on behalf of the Entred Scientific Committee. Regional characteristics of the treated diabetic population in metropolitan France and its medical management. Entred 2001. Bull Epidemiol Hebd 2003,49-50:240-2.

• Scaturro S, Weill A, Simon D, Varroud-Vial M, Vallier N, Petit C, Fagot-Campagna A, on behalf of the Entred Scientific Committee. Characteristics of hospitalizations among treated diabetic patients. Entred 2001. Bull Epidemiol Hebd 2003,49-50:243-4.

• Summary of the main complications associated with diabetes: Objective No. 54 of the Public Health Act: "Ensure monitoring in accordance with the clinical practice guidelines issued by Alfédiam, Afssaps, and Anaes for 80% of people with diabetes by 2008."

• Fagot-Campagna A, Romon I, Poutignat N, Bloch J, on behalf of the Entred Scientific Committee. Non-insulin-treated diabetes: link between the existence of care for a chronic condition and the quality of medical follow-up. Entred data 2001–2003. Revue du Praticien Monograph 2007, 57:2209-16.

• Romon I, Fosse S, Lecomte P, Simon D, Fagot-Campagna A, on behalf of the Entred Scientific Committee. Use of blood glucose meters, data from the Entred study 2001-2002 [pdf - 370 KB]

• Romon I, Fagot-Campagna A, Bloch J, on behalf of the Entred Scientific Committee. Analysis of the relationship between the existence of care for a chronic condition and adherence to best practice guidelines in type 2 diabetes. Entred data 2001-2003 [pdf - 248 KB]