Which are the insulin treatment regimens used in France? The "Schema survey".

OBJECTIVE: To examine how insulin therapy is used in France under real life conditions for type 1 and insulin-treated type 2 patients. MATERIAL AND METHODS: The "Schema survey" was a cross-sectional survey carried out for all the insulin-treated patients seen by participating physicians on a given day. All registered diabetologists in France were invited to participate, 934 initially agreed, 450 returned at least one questionnaire. These 450 physicians appeared to be representative of the whole. The reasons for which 484 physicians who had initially agreed to participate did not were collected by telephone and do not seem to introduce a bias. 1,263 patients were included in the analysis, type 1: 57.6%, type 2: 36.8%. RESULTS: Over 54% of type 1 patients were treated with 3 or more insulin injections per day. Among type 1 patients treated with 2 injections per day, 30% were younger than 18. Over 82% type 2 patients were treated with 1 or 2 insulin injections per day. A regimen combining oral agents and bed time NPH was used in 18% of type 2 patients. Premixed insulins were used by 45.5% of type 2 and 39.5% of type 1 patients. For patients under 3 or more injections per day, over 30 different regimens were identified. About 40% of patients, either type 1 or 2, were poorly controlled (HbA1c > 8.5%). The frequency of blood glucose monitoring appears to comply with recommendations. CONCLUSIONS: Under real life conditions, a majority of French type 1 patients are treated with intensified multiple injections but a lot are not, despite inadequate metabolic control. Only few type 2 patients are treated with intensified therapy.

[Determinants of compliance with antidepressive drugs]. / Déterminants de l'observance thérapeutique des antidépresseurs.

A national survey was conducted in a representative sample of the general French population in order to assess antidepressant non compliance frequency and the factors that influence it. Two types of noncompliance were taken into account: 1) the premature interruption of the treatment; 2) the omission of doses. Data were collected by phone interview. Results show that 36.9% of the 423 included subjects (who represent 4.3% of the sample) were noncompliants (15.4% by treatment interruption and 21.5% by dosage modification). The two types of noncompliance have different risk factors. Treatment interruption was more frequent for patients with high level of schooling (OR = 2.5), in case of multiple take regimens (OR = 3), when the physician did not informed the patient about treatment (OR = 3.3) and when the patients' sources of information were exclusively non medical ones (OR = 3.7). Dosage modification was more frequent in female (OR = 2.1), when the treatment duration exceeded six months (OR = 2.5) and when the prescriber did not communicate with the patient relatives (OR = 1.8). The information delivered by the physician about the duration of the treatment was associated with the two types of compliance but with an opposite effect. This information has a protective effect on treatment interruption (OR = 0.5) but increases the risk of dosage modification (OR = 1.1).