Delay of insulin therapy in type 2 diabetics.

Type 2 diabetes (T2DM) is a progressive disease. Insulin appears early in the therapeutic intensification algorithm, but is still a last resort. This delay is frequent but its duration has been little studied in the Tunisian population. The main objective of this study was to identify and evaluate, in a specialized center, the delay in insulin therapy in type 2 diabetics. This was a retrospective, cross-sectional study of 140 patients. DT2 were included as oral antidiabetic agents, including at least one optimal dose sulfonamide, hospitalized for insulin therapy between January 1, 2014 and December 31, 2015. The delay in insulin therapy was defined by the succession of two HbA1c values ≥8% at least 3 months apart. Its duration, in months, calculated in 90 patients, corresponds to that passed between T0 where HbA1c ≥8% and T1 at the insulin initiation. Our population was 74 women and 66 men, mean age 58.2 ± 11.7 years. The average duration of diabetes was 10.3 ± 6.1 years; mean fasting glucose and HbA1c were 11.9 ± 3.6 mmol / l and 11.3 ± 2%, respectively. The delay in insulin therapy concerned all patients. Its average duration was 39 ± 29 months with extremes of 6 months to 10 years. Mean HbA1c increased significantly from 10 ± 1.5% to 11.2 ± 2% between T0 and T1 (p <10-3). A shift to insulin beyond three years was associated with the duration of diabetes (p = 0.03) and dyslipidemia (p = 0.04). Insulin therapy is late even in a specialized center. This therapeutic inertia is universal. Its causes should be better studied to be better mastered.

Methylenetetrahydrofolate Reductase (MTHFR) (C677T and A1298C) Polymorphisms and Vascular Complications in Patients with Type 2 Diabetes.

OBJECTIVES: To assess whether 2 polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene, C677T and A1298C, are risk factors for vascular complications in Tunisian patients with type 2 diabetes mellitus. METHODS: The MTHFR polymorphisms were genotyped, and plasma homocysteine levels were evaluated in 160 Tunisian patients with type 2 diabetes mellitus. RESULTS: Prevalence of the 2 heterozygous polymorphisms of the thermolabile MTHFR gene (CT and AC) was encountered more commonly in patients with diabetes mellitus than in the healthy controls (p<10-3). Subjects with diabetes had significantly higher homocysteine (Hcy) levels than the control subjects; however, there was no statistical difference in plasma Hcy values between carriers of mutant genotypes (CT/TT for C677T and AC/CC for A1298C) and wild types (CC and AA) in patients with diabetes. Retinopathy was found to be a vascular complication in patients with either the 677CT or the 1298(AC+CC) genotype more commonly than in those with the wild-type genotypes (p=0.003; OR=3.2, 95% CI, 1.4 to 7.4; p<10-3; OR=5.9, 95% CI, 2.7 to 13). Only patients who carry the A1298C mutation (AC+CC) are at risk for at least 1 complication (p=0.002). Double heterozygous mutants were at the greatest risk for retinopathy and for suffering at least 1 complication (p<10-3). CONCLUSIONS: Studies involving a larger study population and various ethnic groups are required before ruling out the role of MTHFR gene in type 2 diabetes mellitus and in vascular complications.