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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.

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This study suggests that the use of dabigatran in French atrial fibrillation patients is cost-effective, according to usually accepted thresholds.

A503were to home, 25% to rehabilitative care then home, 2% to rehabilitative care then a nursing home, 7% to long-term care and 6% of stays ended with a patient death. Of a total cost over 1 year of € 610 million (mean cost per patient of € 20,326), 70% concern the post-acute phase. By increasing the proportion of patients thrombolyzed, costs are reduced primarily by a decrease in rehabilitative care, with savings per additional treated patient of € 1,462. By adding improved timing, savings are more than doubled (€ 3,183 per additional patient). ConClusions: By improving thrombolytic management in stroke units, patient journeys through care pathways can be modified, with increased discharges home, a change in post-acute resource consumption and net savings.

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