Glucagon-like peptide-1 receptor agonists (GLP-1RAs) used in type 2 diabetes promote weight loss, which has led to international misuse. In France, misuse affected 1.3% of patients in 2024, according to data from the French national health insurance (FNHI) system. However, in February 2025, the FNHI introduced a 2-minutes mandatory prescription-support form for all doctors, requiring information it already holds (diabetes status, associated antidiabetic treatments). Because reimbursement indications (ITR) are more restrictive than marketing authorisation, this measure may encourage overprescription of metformin in previously intolerant patients...To assess whether the introduction of this mandatory form has been associated with changes in prescribing patterns for GLP-1RAs and metformin in ambulatory care.We conducted a retrospective, descriptive, population-based study using open-access national reimbursement data from the FNHI (Médic’AM). All reimbursed non-insulin antidiabetic drugs dispensed in community pharmacies between January 2019 and July 2025 were included. Monthly numbers of reimbursed boxes of GLP-1RAs and metformin (alone or in combinations) were analysed. Prescribing volumes during the six months before and after February 2025 were analyzed.Between 2019 and 2024, reimbursed GLP-1RA dispensations increased from 3.1 to 6.3 million boxes annually, while metformin dispensations remained stable (31.5 to 32.1 million boxes). In the six months following implementation of the prescription-support form, monthly GLP-1RA dispensations increased by 9.0%, with no interruption of the prior upward trend. Over the same period, metformin dispensations increased by 2.6%, driven by metformin monotherapy (+3.9%); metformin reached its highest June–July levels in six years.Administrative measure did not reduce the use of GLP-1RAs and may have encouraged adaptive prescribing behaviours focused on compliance with reimbursement rather than clinical appropriateness. Main strength of our work is the use of comprehensive national reimbursement data, limiting selection bias. Main limitation is that we only know the reimbursement: there is no individual clinical indication, information on tolerance, compliance, prescriber characteristics... We also lack hindsight: this work will be completed to track changes in prescribing.This untargeted administrative measure generated additional low-added value administrative workload, equivalent to approximately 10 full-time general practitioners for one year! Regulatory strategies targeting atypical prescriptions (to non-diabetic patients) may be more effective.

Type 2 diabetes is a major and growing public health concern in France, with innovative therapies such as SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1RAs) reshaping treatment recommendations.We aimed to describe the evolution of non-insulin antidiabetic drug prescriptions trends in France between 2014 and 2024.We conducted a retrospective descriptive study based on the Open Medic database from French National Health Insurance, covering annual outpatient drug dispensing in pharmacies that were at least partially reimbursed. All patients who were dispensed at least one non-insulin antidiabetic drug between 2014 and 2024 were included. The primary endpoint of this study was the number of packages of non-insulin antidiabetic drugs dispensed in France between 2014 and 2024. Stratified analyses were conducted according to age group, gender and prescriber specialty.From 2014 to 2024, over 633 million boxes of reimbursed non-insulin antidiabetic drugs were dispensed. Metformin remained the most dispensed treatment during the study period, accounting for 42% of all non-insulin antidiabetic dispensed in 2024. Sulfonylureas declined steadily (from 23% in 2014 to 11% in 2024), while SGLT2i and GLP-1RAs grew sharply after 2019 and surpassed sulfonylureas by 2024, representing 18% and 11% of all non-insulin antidiabetic dispensed, respectively. Endocrinologists were quicker to prescribe these innovative therapies, which were also more commonly initiated in younger patients than other non-insulin antidiabetic drugs. Although dispensed volumes remained relatively stable, total expenditures increased by 66% between 2018 and 2024, with SGLT2 inhibitors and GLP-1 receptor agonists accounting for nearly 80% of antidiabetic drug costs in 2024.These findings illustrate rapid alignment of French clinical practice with international evidence supporting SGLT2i and GLP-1RAs. Their early predominance among endocrinologists and younger patients likely reflects cautious initial use of new therapies, followed by broader diffusion as familiarity increased. However, the widespread uptake of these high-cost agents raises concerns regarding long-term financial sustainability.Over the study period, metformin remained the most frequently dispensed treatment. The introduction of SGLT2i and newer GLP1-ARs was accompanied by a decline in the use of sulfonylureas. Despite relatively stable overall dispensing volumes, expenditures have increased substantially, driven by the higher cost of innovative treatments.

The growing prevalence of diabetes and the increase in the number of elderly people pose challenges for the future. This is happening in a context of digital expansion in healthcare through new technologies such as continuous glucose monitors (CGMs). The perceptions of type 2 diabetic patients regarding digital tools have been little studied, particularly the perceptions of people over the age of 65.Study the perceptions of patients over 65 years of age with type 2 diabetes regarding CGMs.The study was qualitative research based on grounded theory. The population of interest consisted of people over the age of 65 with type 2 diabetes who were eligible for CGMs and had a general practitioner. Recruitment was carried out using theoretical sampling. Twelve semi-structured interviews were conducted with audio recording and triangulation until data saturation was achieved. An explanatory model with a scheme was created.Diabetes status and digital development are two factors contributing to discrimination felt by participants and their social exclusion. Mastering new technologies, particularly CGMs, enables elderly people with diabetes to maintain their independence and integrate into society. However, there are still limitations to the autonomy provided by sensors: measurement reliability, obsession with numbers, and dependence on installation. Finally, the fear of dehumanisation is less than that of a decline in medical demographics and is offset by trust in the attending physician.The strengths of the study are: its relevance to the current context and its rigorous methodology (length of interviews, triangulation, logbook monitoring). The limitations are: a possible social desirability bias and the principal investigator's lack of previous experience. Innovative study with a population that is rarely surveyed.The perception of elderly diabetic patients appears to be positive regarding CGMs, which seem to offer a solution for improving their quality of life. Support and consideration of the criteria for recommending CGMs to elderly diabetic patients must be provided. General practitioners appear to be key players in supporting elderly patients in adopting these new technologies.

South Korea has implemented the pay-for-performance program based on the Health Insurance Review and Assessment Service (HIRA) quality assessment for over a decade.This study examined the long-term clinical and economic effectiveness of the National Diabetes Quality Assessment Program (NDQAP) for patients with diabetes and multiple chronic conditions (MCCs).From the National Health Insurance Claims Database, 428,911 individuals with diabetes who visited a primary care clinic from 1 July 2015 to 30 June 2016 were included and followed up until 31 December 2023. Subgroup analyses were conducted according to the presence of comorbid hypertension and dyslipidemia. The primary exposure was the quality of primary care institutions, defined by accreditation status and performance on quality indicators. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for diabetes complications and all-cause mortality. Medical costs were analyzed using Gamma generalized linear models.During the mean follow-up duration of 7.2 years, utilization of high-quality institutions was associated with a decreased risk of macrovascular complications and all-cause mortality. Consistent results were observed across all patient groups. Among patients with diabetes, hypertension, and dyslipidemia, individuals managed in high-quality institutions had a lower risk of all-cause mortality (HR 0.95; 95% CI 0.92–0.97), cardiovascular disease (HR 0.93; 95% CI 0.92–0.95), cerebrovascular disease (HR 0.93; 95% CI 0.91–0.95), peripheral vascular disease (HR 0.90; 95% CI 0.88–0.91), and heart failure (HR 0.90; 95% CI 0.88–0.93) than those who were not managed in high-quality institutions. Individuals managed in institutions with higher quality indicator scores incurred 14–18% lower total medical costs.The achievement of NDQAP indicators was associated with a decreased risk of diabetes complications, all-cause mortality, and long-term healthcare expenditures for patients with MCCs.These findings support strengthening financial incentives for institutions that improve health outcomes and reduce healthcare costs in South Korea.

Diabetes mellitus is a complex chronic disease that requires continuous medical care and in which, beyond glycemic control. many strategies to reduce multifactorial risks are required. Moderate or intense physical exercise is recommended  at all stages of diabetes, being able to prevent complications of the disease and optimize the quality of life of patients.The present  paper specifies the practical aspects of establishing and individualizing kinetic programs in diabetes in a primary care setting,  trying to answer the questions: how much, how and in what way is physical rehabilitation in diabetic patients performed? The principles of the kinetic programs are presented, but also the basic rules for the application of the rehabilitation program and  the ways of achieving the isotonic or isometric effort in these patients.  The contraindications but also the precautions related to the physical training of diabetic patients cannot be missing.The lesson to be learned from this work is that the family doctor must know and recommend an adapted, supervised and progressive physical exercise program for each patient with diabetes under his care.Physical rehabilitation is an integral part of Diabetes Self Management Education and Support (DSMES) and  should be encouraged in all patients with diabetes!  Physical exercise  is indicated in all  stages of DM and is part of the therapeutic objectives in DM: -prevention of complications -optimizing the quality of life -movement therapy acts on the pathogenic links of DM - into the SMART program ( specific, measurable, achievable, realistic, in time)The implication of family doctor in the supervised psysical training programms, strictly individualized, progressive and applied as a true lifestyleof patients with diabetes mellitus,along with diet and recommended medication will reduce the complications of the disease, will significantly improve the quality of life of these patients and will increase their life expectancy.

Type 2 diabetes melitus (T2DM) affects 5.6% of French population with an increasing prevalence. HbA1c is the standard biomarker for long-term monitoring in T2DM. While its biomedical value is well established, much less is known about how patients perceive HbA1c and how they integrate it into their daily self-management. Understanding these representations is essential for improving therapeutic education and shared decision-making in primary care. This study explores the personal meanings and emotional representations patients attribute to HbA1c, capillary blood glucose monitoring, and continuous glucose monitoring (CGM).Exploring how patients with T2DM understand and interpret HbA1c, how they relate it to their daily glucose self-monitoring practices, and how these perceptions shape their sense of control and autonomy.This qualitative study, inspired by grounded theory, was conducted between August 2023 and April 2024. Eleven semi-structured interviews were carried out with adults living with T2DM, recruited in general practice and a rehab center. Interviews were audio-recorded, transcribed verbatim and analysed via open, axial, and selective coding with methodological triangulation.HbA1c is perceived as important: a tool for knowledge and control, a target to aim. Self-monitoring of blood glucose allows daily monitoring and adaptation of lifestyle. CGM appears more precise but for complex cases. HbA1c limits are the inability to act on it and the feeling to be left unprotected from T2DM complications. The core idea was the refusal to endure the disease as the focal point from positive perceptions of HbA1c: helping keeping control of diabetes, and negative ones with the will to preserve freedom and autonomy.Patients attribute strong symbolic value to HbA1c. Its lack of immediate actionability explains why daily capillary monitoring remains emotionally and practically essential. Therefore, those results are questioning the recommendations about T2DM monitoring. Most importantly, it questions the goal of patients to reduce the burden of the disease and its treatments with regards to the actual guidelines.This study highlights perceptions, concerns and expectations from type 2 diabetes patients, that we hope will help professionals providing better patient education and patient centered approach of care.

Type 2 diabetes mellitus (T2DM) is a major determinant of cardiovascular (CV) diseases. Statins significantly reduce CV events in high- and very high-risk patients. The 2021 European Society of Cardiology (ESC) guidelines classified most patients with T2DM in primary prevention as having “high” or “very high” CV risk according to diabetes complications. In contrast, the 2023 ESC guidelines introduced the SCORE2-Diabetes, which integrates diabetes-specific parameters (such as age, gender, HbA1c…) to enable more individualized CV risk assessment.To compare (1) CV risk estimations according to ESC 2021 and SCORE2-Diabetes classifications, and (2) the proportion of patients with statin indication (high and very high risk), in an ambulatory population of patients with T2DM.We conducted a retrospective observational study across 15 general practices. Data from pro.ameli.fr and electronic medical records of the investigating general practitioners were used to collect diabetes- and CV-related characteristics of patients aged 40–69 years with T2DM and no prior CV disease. Agreement between the ESC 2021 and SCORE2-Diabetes classifications was evaluated using Cohen’s kappa coefficient. Comparisons were performed with McNemar’s test and multivariable logistic regression.Among 817 patients screened, 209 patients with T2DM were included (men: 45%; mean age: 57 ± 9 years; mean HbA1c: 7.8 ± 1.6%). According to ESC 2021, 42% of patients were classified as high or very high CV risk, compared with 34% using SCORE2-Diabetes (p=0,004). Agreement between classifications was poor (κ= 0.16). Discrepancies were mainly driven by the inclusion of age (p < 0.01) and blood pressure (p = 0.01) increasing CV risk in the SCORE2-Diabetes, and by the albumin–creatinine ratio (p < 0.01) in ESC 2021.This study provides the first comparison of ESC 2021 and SCORE2-Diabetes risk classifications in a real-world ambulatory population. However, our sample may not be fully representative, and no randomized clinical trials have yet assessed statin prescription outcomes based on SCORE2-Diabetes.Implementation of the SCORE2-Diabetes resulted in lower estimated CV risk and may reduce statin prescriptions among patients with T2DM in primary prevention. Further studies are warranted to evaluate the clinical, economic, and iatrogenic implications of such reclassification.