Aim. - To explore the frequency of hypoglycaemic episodes, their risk factors, and associations with patient-reported outcomes in patients with type 2 diabetes enrolled in the PANORAMA cross-sectional study.Methods. - Five thousand seven hundred and eighty-three patients aged >= 40 years with type 2 diabetes duration >= 1 year were recruited in nine European countries. Patients reported severe and non-severe hypoglycaemic episodes during the past year at a single study visit. Patient-reported outcomes were measured by the Audit of Diabetes-Dependent Quality of Life, Diabetes Treatment Satisfaction Questionnaires, Hypoglycaemia Fear Survey-II, and EQ-5D Visual Analog Scale.Results. - During the previous year, 4.4% of the patients experienced >= 1 severe hypoglycaemic episode; among those without severe hypoglycaemia, 15.7% experienced 2:1 non-severe episode. Patients experiencing any hypoglycaemic episode reported a greater negative impact of diabetes on quality of life, greater fear of hypoglycaemia, less treatment satisfaction and worse health status than those with no episodes. In multivariate analyses hypoglycaemia was significantly associated with longer diabetes duration; presence of microvascular and, to a lesser extent, macrovascular complications; treatment with insulin, glinides or sulfonylureas; and use of self-monitoring blood glucose.Conclusion. - In patients with type 2 diabetes, severe hypoglycaemic episodes were not uncommon and one in five experienced some form of hypoglycaemia during the previous year. Hypoglycaemia was associated with more negative patient-reported outcomes. The risk of hypoglycaemia increased with diabetes duration, presence of diabetes-related complications, use of self-monitoring blood glucose, insulin secretagogues, and insulin treatment. (C) 2015 Elsevier Masson SAS. All rights reserved.

AIMS:To compare the 5-year mortality (overall and cause-specific) of a cohort of adults pharmacologically treated for diabetes with that of the rest of the French adult population.METHODS:In 2001, 10 000 adults treated for diabetes were randomly selected from the major French National Health Insurance System database. Vital status and causes of death were successfully extracted from the national registry for 9101 persons. We computed standardized mortality ratios.RESULTS:Over 5 years, 1388 adults pharmacologically treated for diabetes died (15% of the cohort, 32.4/1000 person-years). An excess mortality, which decreased with age, was found for both genders [standardized mortality ratio 1.45 (1.37-1.52)]. Excess mortality was related to: hypertensive disease [2.90 (2.50-3.33)], ischaemic heart disease [2.19 (1.93-2.48)], cerebrovascular disease [1.76 (1.52-2.03)], renal failure [2.14 (1.77-2.56)], hepatic failure [2.17 (1.52-3.00)] in both genders and septicaemia among men [1.56 (1.15-2.09)]. An association was also found with cancer-related mortality: liver cancer in men [3.00 (2.10-4.15)]; pancreatic cancer in women [3.22 (1.94-5.03)]; colon/rectum cancer in both genders [1.66 (1.28-2.12)]. Excess mortality was not observed for breast, lung or stomach cancers.CONCLUSIONS:Adults pharmacologically treated for diabetes had a 45% increased risk of mortality at 5 years, mostly related to cardiovascular complications, emphasizing the need for further prevention. The increased risk of mortality from cancer raises questions about the relationship between cancer and diabetes and prompts the need for improved cancer screening in people with diabetes.

Un risque modérément accru de cancer, en particulier digestif, est bien établi chez les sujets diabétiques de type 2 ou ayant des anomalies mineures de glyco-régulation. Cette association semble passer par l’hyperinsulinémie liée à l’insulinorésistance et par l’influence de l’insuline et des facteurs de croissance sur la prolifération cellulaire. Le rôle de l’hyperglycémie dans cette relation paraît beaucoup plus incertain. Il est essentiel d’améliorer le mode de vie des populations pour réduire l’obésité, et ainsi freiner l’expansion du diabète, du cancer et des maladies cardiovasculaires à travers le monde.

Aim. - Type 2 diabetes mellitus (T2DM) is often associated with chronic kidney disease. For this reason, this article reviews the relationship between treatment of T2DM and renal disease.Method. - The review presents the recent French data on the management of diabetes in patients with renal impairment, and discusses the implications of renal disease for the treatment of such patients. Prescribing data are presented for various antidiabetic treatments, and the use of the more commonly prescribed medications is discussed with reference to T2DM patients with renal disease.Results. - In France, it is estimated that 4-5% of the general population has T2DM and that almost 40% of patients with end-stage renal failure have diabetes. Diabetes and renal disease are both risk factors for cardiovascular morbidity and mortality. Glycaemic control is pivotal in T2DM patients for minimizing the risk of vascular complications and hypoglycaemic episodes, particularly in patients with renal disease who also have a higher risk of hypoglycaemia. Whereas poorly controlled glycaemia increases the risk of renal disease and its progression, the risk is diminished in patients treated intensively for diabetes and in those who achieve stable glycaemic control. Intensive multitargeted treatment can also help to decrease cardiovascular morbidity and mortality, especially if started early in patients who have not yet developed macrovascular complications.Conclusion. - In recent years, considerable improvement has been observed in France regarding the follow-up of diabetic patients. Less extensive, but nonetheless significant, improvement has also been observed in glycaemic control. However, even though treatment decisions generally take renal function into account, some at-risk treatments are often still being used in patients with renal insufficiency. (C) 2011 Elsevier Masson SAS. All rights reserved.

Fragestellung: PANORAMA ist eine europäische Querschnittsstudie an Typ 2 Diabetikern, welche Behandlungsmuster, Blutzuckerkontrolle und Patienten-berichtete Ergebnisse (patient reported outcomes-PRO) erfasst. In dieser Auswertung werden die Daten der deutschen Kohorte in Abhängigkeit vom HbA1c (<6,5%, 6,5–7%, ≥7,5%) dargestellt.

L'hypoglycémie est un effet secondaire majeur fréquemment rencontré chez les patients traités par antidiabétiques. PANORAMA est une vaste étude épidémiologique européenne transversale visant à évaluer la qualité de vie et la satisfaction des patients diabétiques de type 2 (DT2) vis-à-vis de leur traitement. La présente analyse évalue leur lien avec les hypoglycémies chez des patients DT2. Des patients DT2 âgés de 40 ans et plus diagnostiqués depuis au moins un an ont été inclus dans 9 pays européens en s'efforçant d'obtenir un échantillon représentatif. Les patients étaient traités par régime seul, antidiabétiques oraux ou injectables (insuline ou analogues du GLP-1), sans modification du traitement durant les 3 mois précédant l'inclusion. Les patients ont répondu à des questionnaires sur leur qualité de vie (questionnaire ADDQoL), sur leur satisfaction du traitement (questionnaire DTSQ) et sur leur crainte du risque de survenue d'hypoglycémies (questionnaire HFS-II). 5,817 patients ont été inclus en Europe, dont 759 en France entre juin 2009 et février 2010 : 46,3 % étaient des femmes ; l'âge moyen était de 65,9 ans. 4,5 % des patients ont présenté au moins un épisode d'hypoglycémie sévère dans les 12 mois précédents. Ces patients rapportaient une altération de la qualité de vie significativement plus marquée (ADDQoL, p < 0.001), étaient moins satisfaits de leur traitement (DTSQ, p < 0.0014) et présentaient le plus d'inquiétude face à la survenue d'éventuelles hypoglycémies (HFS-II, p < 0.001) par comparaison aux patients n'ayant pas vécu d'hypoglycémies sévères. Des résultats similaires étaient observés chez les 16 % des patients rapportant plus d'un épisode hypoglycémique modéré par mois, par rapport aux patients rapportant moins d'une hypoglycémie par mois (p < 0.001). En France, 10 % des patients DT2 déclaraient craindre fréquemment ou presque tout le temps d'avoir des hypoglycémies sans personne autour pour les aider ; 25 % déclaraient les craindre de temps en temps, fréquemment ou souvent. La survenue d'épisodes hypoglycémiques sévères et modérés chez le patient DT2 est associée à un impact négatif sur sa qualité de vie, à une moindre satisfaction du traitement et à une plus grande peur des conséquences de l'hypoglycémie. Le risque d'hypoglycémie associé à certains traitements antidiabétiques constitue certainement un frein à l'adhésion du patient à son traitement.

Le rôle probable de la résistance à l’insuline et de l’insulinémie dans l’association diabète (ou hyperglycémie) et risque de cancer est fortement suggéré par les études de pharmaco-épidémiologie qui, dans l’ensemble, indiquent un risque accru de cancer avec les traitements du diabète entraînant une hyperinsulinémie, et un effet protecteur de la metformine et vraisemblablement aussi des glitazones, vis-à-vis du cancer. En ce qui concerne un effet spécifique de l’insuline glargine pour favoriser la survenue du cancer, l’étude allemande qui a fait naître le soupçon comportait de nombreux biais méthodologiques et n’a pas été confirmée dans trois autres études ad hoc. La multiplication d’études de pharmaco-épidémiologie de qualité est nécessaire pour éclairer le débat sur ce sujet essentiel pour les patients diabétiques de type 2 et pour la santé publique. The role of insulin resistance and plasma insulin level in the association between diabetes (or hyperglycemia) and cancer risk is strongly suggested by pharmacoepidemiological studies. Most of them show an increased risk of cancer with antidiabetic treatments inducing hyperinsulinemia, and a protective effect of metformine and probably also thiazolidinediones towards cancer. Concerning a specific effect of insulin glargine to increase cancer risk, the German study which raised the suspicion accumulated a number of methodological pitfalls and its results were not confirmed in three ad hoc studies. Additional phamacoepidemiological studies well designed are needed to investigate this issue which carries major consequences for type 2 diabetic patients and public health.

To assess how general practitioners (GPs) in France adapt their anti-diabetic therapeutic strategies among type 2 diabetes mellitus (T2DM) patients who also had chronic kidney disease (CKD). A multi-centric cross-sectional and retrospective study was undertaken, investigating patient characteristics, disease severity, therapeutic strategies, reasons for changes thereof through questionnaires filled by GPs, coupled with drug treatments extracted from the IMS Disease Analyser database. The study sample included 120 T2DM patients (median age = 76.0, 45% men): 37 with stage 3a CKD (45≤GFR<60 ml/min, median age = 75.1, 57% men) and 83 with stage 3b or severe CKD (GFR <45 ml/min, median age = 76.4, 38% men). Oral anti-diabetic treatments were widely prescribed among CKD patients: of those with stage 3a and 3b, respectively 37.5% and 39.3% had oral monotherapy, while 40.6% and 28.6% had oral double or triple therapy. 21.9% and 32.1% had insulin therapy (3 a and 3 b, respectively). 65% of patients were treated with an anti-diabetic drug which is either contraindicated or not recommended for CKD patients; GPs adapted the anti-diabetic strategy during the previous year for 43% patients, 53% of the time due to CKD. Mean HbA1c was 7.1% and 7.2% among CKD stage 3a and 3b patients, respectively; with 58% (3a) and 54% (3b) having HbA1c<7. Only 23% of patients achieved control of diabetes (GP assessment), with treatment that does not include a drug either contraindicated or not recommended for this patient group; 2/3 of these patients received insulin. Treating T2DM patients with CKD remains a challenge for GPs: data suggest that GPs are favouring glycemic control over safety by using anti-diabetic drugs that are either contraindicated or not recommended for CKD patients. New oral treatments that would allow physicians to control glycemia while appropriately considering impaired renal function are needed.

Le concept d’inertie thérapeutique, un retard à l’intensification du traitement en cas de contrôle insuffisant d’une maladie, peut s’appliquer à toutes les pathologies chroniques. Dans le cadre du diabète de type 2, il peut concerner aussi bien le traitement antidiabétique que les traitements des différents facteurs de risque cardio-vasculaire (hypertension artérielle, dyslipidémie).

Sauf pour la prostate, il existe un risque modérément accru de cancer, en particulier digestif, chez les diabétiques de type 2 et les sujets ayant des anomalies frustes de la glycorégulation, indépendamment de l’obésité. Le mécanisme le plus plausible passe par l’insulinorésistance avec hyperinsulinémie, et par l’influence de l’insuline et des facteurs de croissance circulants sur la prolifération cellulaire. Des mesures de prévention s’imposent devant l’expansion de ces deux grands fléaux pour la santé publique, en proposant à toute la population des modifications du mode de vie (alimentation, activité physique) qui réduiront dans le même temps l’obésité et les maladies cardiovasculaires. A moderate increase of cancer risk has been shown in diabetic patients and in subjects with abnormal glucose tolerance, mainly in digestive sites, independently of obesity, with on the contrary a protective effect for prostate cancer. Insulin resistance with compensatory hyperinsulinemia, and elevated levels of circulating growth factors are usually considered as the link between cancer and hyperglycemia, through activated cell proliferation. Greater public awareness about healthy lifestyles (diet, physical activity) is needed to prevent these two major increasing public health issues, and in the meanwhile should reduce the frequency of obesity and cardiovascular diseases in the whole population.

Introduction Le diabete de type 2 (DT2) est un facteur de risque majeur associe a la survenue de complications micro et macro-vasculaires. L'objectif therapeutique chez les patients DT2 sans antecedents cardiovasculaires est l'obtention d'une HbA1c Patients et methodes Des patients DT2 âges de 40 ans et plus diagnostiques depuis au moins un an ont ete inclus dans 9 pays europeens en s'efforcant d'obtenir un echantillon representatif. Les patients etaient traites par regime seul, antidiabetiques oraux (ADO) ou injectables (insuline ou analogues du GLP-1), sans modification du traitement durant les 3 mois precedant l'inclusion. L'HbA1c a ete mesuree de facon standardisee (Bayer A1cNow+ ® ) lors de la consultation. Resultats 5,817 patients ont ete inclus en Europe, dont 759 en France (Fr) entre juin 2009 et fevrier 2010 : 46,3 % etaient des femmes (Fr : 37 %) ; l'âge moyen etait de 65,9 ans (Fr : 65,7 ans). 68,1 % des patients ne prenaient que des ADO (Fr : 77,3 %), 6,9 % uniquement de l'insuline (Fr : 4,4 %) et 13,2 % des ADO plus insuline (Fr : 12,3 %). L'HbA1c moyenne etait de 6,9 % (Fr : 7,0 %) et seulement 39,6 % des patients avaient une HbA1c Conclusion La prise en charge therapeutique actuelle du patient DT2 est insuffisante pour permettre l'atteinte des objectifs glycemiques fixes par les recommandations. Ces resultats suggerent qu'une escalade therapeutique plus precoce, associee a des regles hygieno-dietetiques adaptees, permettrait un meilleur controle glycemique chez les patients DT2.

Diabet. Med. 28, 1311–1318 (2011)AbstractAim We examined the ability of fasting plasma glucose and HbA1c to predict 5‐year incident diabetes for an Australian cohort and a Danish cohort and 6‐year incident diabetes for a French cohort, as defined by the corresponding criteria.Methods We studied 6025 men and women from AusDiab (Australian), 4703 from Inter99 (Danish) and 3784 from DESIR (French), not treated for diabetes and with fasting plasma glucose < 7.0 mmol/l and HbA1c < 48 mmol/mol (6.5%) at inclusion. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l and/or treatment for diabetes or as HbA1c ≥ 48 mmol/mol (6.5%) and/or treatment for diabetes.Results For AusDiab, incident fasting plasma glucose‐defined diabetes was more frequent than HbA1c‐defined diabetes (PMcNemar < 0.0001), the reverse applied to Inter99 (PMcNemar < 0.007) and for DESIR there was no difference (PMcNema = 0.17). Less than one third of the incident cases were detected by both criteria. Logistic regression models showed that baseline fasting plasma glucose and baseline HbA1c predicted incident diabetes defined by the corresponding criteria. The standardized odds ratios (95% confidence interval) for HbA1c were a little higher than for fasting plasma glucose, but not significantly so. They were respectively, 5.0 (4.1–6.1) and 4.1 (3.5–4.9) for AusDiab, 5.0 (3.6–6.8) and 4.8 (3.6–6.3) for Inter99, 4.8 (3.6–6.5) and 4.6 (3.6–5.9) for DESIR.Conclusions Fasting plasma glucose and HbA1c are good predictors of incident diabetes defined by the corresponding criteria. Despite Diabetes Control and Complications Trial‐alignment of the three HbA1c assays, there was a large difference in the HbA1c distributions between these studies, conducted some 10 years ago. Thus, it is difficult to compare absolute values of diabetes prevalence and incidence based on HbA1c measurements from that time.

Objectif Comparer le nombre de cas incidents de diabete (DM) lorsqu’il est defini soit par une HbA1c = 6,5 %, soit par une glycemie a jeun (GAJ) = 7,0mmol/l, soit par un traitement pour le diabete. Materiels et Methodes Nous avons suivi 2 618 sujets non traites de la cohorte AusDiab, 4 663 de Inter99 et 3 459 de D.E.S.I.R qui etaient definis indemne de diabete par la GAJ et l’HbA1c a l’inclusion. La periode de suivi etait de 5 ans pour AusDiab et Inter99 et 6 ans pour D.E.S.I.R et les sujets etudies etaient âges de 30 a 61 ans a l’inclusion. Les distributions de l’HbA1c etaient differentes entre les 3 cohortes, nous avons donc standardise les donnees d’HbA1c de AusDiab et Inter99 sur les donnees de D.E.S.I.R assignat la meme moyenne et le meme ecart-type aux donnees des 3 cohortes. Resultats Les moyennes (ecart-type) a l’inclusion de GAJ (mmol/l) etaient de : 5,3 (0,5), 5,5 (0,5) et 5,3 (0,5) et d’HbA1c (%) etaient de : 5,4 (0,4) apres standardisation. Dans Inter99, l’incidence du DM est la plus elevee avec les deux definitions ; les incidences de DM defini par la GAJ ou par l’HbA1c sont similaires pour Inter99 et D.E.S.I.R. Mais plus elevees avec l’HbA1c pour AusDiab (PMcNemar DM incident par HbA1c GAJ HbA1c & GAJ AusDiab 126 (4,8 %) 77 (2,9 %) 51 Inter99 233 (5,0 %) 227 (4,9 %) 196 DESIR 54 (1,6 %) 66 (1,9 %) 40 Les modeles logistiques montrent que la GAJ a l’inclusion est predictive du DM defini par la GAJ, et l’HbA1c a l’inclusion est predictive du DM defini par l’HbA1c. Ces modeles permettent une bonne discrimination (c > 0,73) et suivent bien les incidences observe (pHosmer-Lemeshow > 0,11). Conclusion Meme si les deux definitions de DM ne depistent pas toujours les memes individus, l’HbA1c a l’inclusion predit bien le diabete defini par l’HbA1c et de meme, la GAJ a l’inclusion predit le diabete defini par GAJ.

To the Editor: In their recent paper, Hemkens et al. conclude that their ‘results based on observational data support safety concerns surrounding the mitogenic properties of glargine in diabetic patients’, because given ‘the overall relationship between insulin dose and cancer, and the lower dose with glargine, the cancer incidence with glargine was higher than expected compared with human insulin’ [1]. Indeed, if it is obvious that the mean daily insulin dose was lower in insulin glargine compared with human insulin users (25.9 ± 22.5 vs 43.8 ± 37.4 IU), and if, using models to adjust for a few potential confounders, a higher incidence of malignant neoplasms was found with insulin glargine at similar insulin dose, in our opinion, this does not support any safety concern surrounding the mitogenic properties of insulin glargine in diabetic patients. I will demonstrate this in two steps. First, over-adjustment for insulin doses should be considered. Unfortunately, Hemkens et al. did not report data concerning glycaemic control. If identical glycaemic control had been obtained in the treatment groups, using lower doses in insulin glargine users, adjustment for insulin dose would not have been appropriate. However, two randomised clinical trials in which insulin glargine and NPH insulin were up-titrated to reach identical glycaemic targets have shown no difference between insulin glargine and human insulin in terms of the dose needed: 68 ± 39 vs 70 ± 42 IU (NS) in the Lantus plus Metformin (LANMET) Study [2], and 32.1 ± 17.6 vs 32.8 ± 18.9 IU (NS) in the Lantus Evaluation in Asian Diabetics (LEAD) Study [3], respectively. Furthermore, the Treat-to-Target Trial reported that higher doses of insulin glargine were needed: 47.2 ± 24.9 vs 41.8 ± 25.6 IU (p < 0.005) [4]. Therefore, the hypothesis of over-adjustment can be ruled out, and it can be deduced that poorer glycaemic control was achieved in the insulin glargine-treated group in the study by Hemkens and colleagues [1], as it was in the Scottish diabetic population studied [5]. It is thus important to understand the reason why a higher glycaemic target was set for the patients treated with insulin glargine. As a positive association between the length of exposure to high levels of plasma glucose and the risk of developing diabetes-related microvascular complications has been demonstrated [6] and is well known by physicians, the most probable explanation for the less ambitious glycaemic control aimed for in the insulin glargine-treated group is that these patients were considered by their practitioners to have a shorter life expectancy than those treated by other insulin regimens. This suggests an allocation bias to be present in the study by Hemkens et al. [1], as acknowledged by the SDRN Epidemiology Group in the Scottish paper [5]. As the insulin glargine users were not older than the human insulin users (69.5 ± 11.6 vs 69.6 ± 13.1 years, respectively), it probably means that they were in worse health. This is not obvious from the few baseline characteristics shown in Table 1 of the paper by Hemkens et al., which were used for multiple adjustments. Therefore, one can only speculate on the reasons why the insulin glargine-treated patients were supposed to have a shorter life-expectancy in their practitioner’s mind, and can only imagine the characteristics that differed between the two groups at baseline that could not, unfortunately, be adjusted for. As the authors conclude that there is a higher cancer incidence during the very short follow-up period (mean 1.63 years, median 1.41 years), a possible explanation, the simplest, is that, at least for some of the diabetic patients treated with insulin glargine, the practitioner knew they had a cancer that was not yet registered in the health insurance fund. Indeed, this provocative suggestion becomes plausible when one examines the procedures used to select ‘adult patients without known malignant disease’, as the authors state that they ‘considered participants to be without known malignant disease if they had not received a corresponding diagnosis within 3 years prior to inclusion in the study’, and that they ‘excluded participants with the slightest suspicion of a malignant disease (e.g. patients with the ICD-10 [International Classification of Diseases, 10th revision, German Modification] diagnosis Z03.1—observation for suspected malignant neoplasm)’ [1]. This information seems to mean that the coding forms in the hospital records were the only source for diagnosing a previous cancer and to exclude an insulin-treated diabetic patient. Table 1 of the paper [1] shows that the insulin glargine-treated patients had been hospitalised less often than the human insulin users in the three preceding years (35.5% had one or two hospital stays, and 16.2% had more than two hospital stays vs 41.3% and 23.4%, respectively, p < 0.0001). Thus, the explanation for the results reported could be that some diabetic patients having a recent cancer were included by error. Their practitioner knew they had cancer, treated them with insulin glargine and set the glycaemic target at a higher level, using lower insulin doses. As they had not yet been hospitalised, cancer had not been notified to the health insurance fund. Second, in spite of multiple comparisons and multiple models, we are told that because the study was intended to generate hypotheses, no adjustments were made for multiple testing’ [1], and a paper whose author list includes Bender, a coauthor of the Hemkens et al. study, is cited to justify that decision [7]. In the paper by Bender and Lange it is written that ‘“Significant” results based upon exploratory analyses should clearly be labelled as exploratory results. To confirm these results the corresponding hypotheses have to be tested in further confirmatory studies.’ [7]. Indeed, even if we can accept this opinion in general, which could be challenged, it is unacceptable in the situation of diabetes treatment and cancer risk, as no confirmatory study using a randomised design can be performed now or in the future to validate, or, more probably, to refute the hypothesis of a causal association between insulin glargine and cancer risk, for obvious ethical and practical reasons. Therefore, to have raised a scientific issue that will never be resolved, by using a flawed methodology, is unethical. In conclusion, probably the right and safe decision would have been to adopt the opinion of the three of the six referees who initially recommended rejection [8], and not publish the study by Hemkens et al., especially given that the Editorial accompanying the publication states: ‘There is no evidence of an overall increase in the rate of cancer development in patients on insulin glargine, and some suggestion that the risk may actually be reduced.’ [8]. Unfortunately, the rumour is spreading now, and it is a pity to have troubled for a long time, probably forever, many diabetic patients who were using glargine insulin, often with great satisfaction, as well as their care providers.

Décrire les caractéristiques et la prise en charge médicale des personnes diabétiques en outre-mer (DOM) et les comparer à celles de métropole. 855 adultes résidant en DOM, traités pour diabète et bénéficiaires du régime général d'Assurance maladie (CnamTS) ou du régime social des indépendants (RSI) ont été tirés au sort. Les données de consommation médicale de l'année ont été extraites pour tous et les complications du diabète ont été recueillies par questionnaire téléphonique (34 % de répondants). L'âge moyen des personnes diabétiques en DOM (n = 855) était de 63 ans (-2 ans par rapport à la métropole), 35 % étaient des hommes (-19 points par rapport à la métropole) et 32 % bénéficiaient de la CMU (+26 pts). Près du tiers des personnes (31 %) étaient traitées par insuline (+10 pts). Chez les 278 personnes diabétiques de type 2 ayant répondu au questionnaire, l'ancienneté moyenne du diabète était de 11 ans comme en métropole, 65 % étaient en surpoids ou obèses (-17 points par rapport à la métropole), 7 % déclaraient fumer (-3 pts), 9 % déclaraient un antécédent d'infarctus du myocarde ou d'angor (-8 pts), 4 % une revascularisation coronaire (-7 pts), 7 % un accident vasculaire cérébral (+1 pt) et 7 % un mal perforant plantaire (-2 pts). Dans l'ensemble (n = 855), 75 % des personnes avaient bénéficié dans l'année d'un dosage de créatininémie (-5 pts) et 71 % d'un dosage de lipides (0 pt). Seulement 30 % avaient bénéficié de 3 dosages d'HbA1c (-9 pts), 45 % d'un dosage d'albuminurie (+20 pts) et 6 % avaient consulté un endocrinologue libéral (-3 pts). Un quart des personnes (26 %) ont été hospitalisées dans l'année (-5 pts). La population diabétique des DOM est plus jeune qu'en métropole, plus féminine, économiquement moins favorisée et plus souvent traitée par insuline à ancienneté du diabète égale. Le profil de risque vasculaire et le niveau de complications sont meilleurs en DOM, sans doute en lien avec un âge plus jeune. La réalisation annuelle de 3 dosages d'HbA1c est peu fréquente. Le dosage de l'albuminurie est également insuffisamment réalisé, mais plus fréquent qu'en métropole. Les estimations de prise en charge médicale ne tiennent toutefois pas compte des consultations et actes réalisés à l'hôpital.