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International Journal of Endocrinology
Volume 2013 (2013), Article ID 640632, 6 pages
http://dx.doi.org/10.1155/2013/640632
Research Article

Glucose Lowering Therapeutic Strategies for Type 2 Diabetic Patients with Chronic Kidney Disease in Primary Care Setting in France: A Cross-Sectional Study

1IMS Health France, 5-7 Place de la Pyramide, 92088 Paris La Défense, France
2Cemka-Eval, 43 Boulevard du Maréchal Joffre, 92340 Bourg-la-Reine, France
3Medical office, 4 Rue de L’Ile de France, 91860 Epinay sous Senart, France
4Nephrology Department, Hôpital Necker-Enfants Malades, 149 Rue de Sèvres, 75015 Paris, France
5Diabetes Department, Hôpital de la Pitié-Salpétrière, 47 Boulevard de l’Hôpital, 75013 Paris, France
6INSERM CESP, U-1018, Villejuif, 94800, France
7Endocrinology Department, Hôpital du Bocage, 1 Boulevard Jeanne d'Arc, 21079 Dijon, France
8Boehringer-Ingelheim France, 14 Rue Jean Antoine de Baïf, 75013 Paris, France

Received 4 January 2013; Accepted 20 February 2013

Academic Editor: Ilias Migdalis

Copyright © 2013 N. Grandfils et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Aim. To understand glucose lowering therapeutic strategies of French general practitioners (GPs) in the management of type 2 diabetes mellitus (T2DM) patients with chronic kidney disease (CKD). Methods. A multicenter cross-sectional study was conducted from March to June 2011 among a sample of French GPs who contribute to the IMS Lifelink Disease Analyzer database. Eligible patients were those with T2DM and moderate-to-severe CKD who visited their GPs at least once during the study period. Data were collected through electronic medical records and an additional questionnaire. Results. 116 GPs included 297 patients: 86 with stage 3a (Group 1, GFR = 45–60 mL/min/1.73 m2) and 211 with stages 3b, 4, or 5 (Group 2, GFR < 45 mL/min/1.73 m2). Patients’ mean age was approximately 75 years. Insulin was used in 19% of patients, and was predominant in those with severe CKD. More than two-thirds of patients were treated with glucose lowering agents which were either contraindicated or not recommended for CKD. Conclusion Physicians most commonly considered the severity of diabetes and not CKD in their therapeutic decision making, exposing patients to potential iatrogenic risks. The recent patient oriented approach and individualization of glycemic objectives according to patient profile rather than standard HbA1c would improve this situation.