Audit of glycemic control of diabetic patients on insulin analogues: about 2915 insured persons of the CNAM (Tunisia)

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Published May 13, 2022
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Vol. 100 No. 6 (2022): Issue Juin 2022

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Skander Dogui
Yosra Htira
Chaima Jemai
Kaouther Aloui
Asma Sfar Gandoura
Wafa Echater
Faika Ben Mami

Abstract

Background: Insulin analogues are increasingly prescribed in Tunisia. These molecules, covered by the National Health Insurance Fund
(CNAM) in Tunisia under certain conditions, have an important and constantly increasing cost.

Aim: To audit the diabetes control among insured in the Northern district of the CNAM (Tunisia), treated with insulin analogues in 2019 and to
assess factors associated with good glycemic control.

Methods: Retrospective observational study including patients with diabetes who applied for renewal of insulin analogues between March and
April 2019 in the northern district of the CNAM.

Results: Our study included 2915 diabetic insured. The sex ratio was 1.08. The mean age was 56.5 ±18.56 years. More than half of the diabetic
insured were followed by a specialist physician (44% by endocrinologists, 7% by internists, 6% by nutritionists and 4% by other specialists).
The average duration of treatment with insulin analogues was 5 years ± 1.41. Almost three quarters (74%) of the diabetic insured were type 2
diabetics. The mean daily dose of rapid-acting, short-acting and premixed insulin analogues were 30±15.49 IU/d, 38±18.36 IU/d and 65±19.38
IU/d respectively. HbA1c targets were achieved in 8% of the diabetic insured. In univariate analysis, the variables significantly associated with
diabetes balance were follow-up by a physician specializing in endocrinology (OR=3.14, 95% CI [0.98-10.08]), internal medicine (OR=5.06,
95% CI [1.49-17.21]) or nutrition (OR=2.06, 95% CI [0.54-7.77]), type 1 diabetes (OR=1.67, 95% CI [1.26-2.22]) and basal insulin therapy
regimen (OR=1.88, 95% CI [1.39-2.54]). In multivariate analysis, the independent and significant factors associated with glycemic control were
type 1 diabetes (ORa=1.81, 95% CI [1.37-2.39]) and basal insulin therapy regimen (ORa= 1.77, 95% CI [1.30-2.40]).

Conclusion: This study showed that the majority of diabetic insured on insulin analogues had a poor controlled diabetes. Type 1 diabetes and basal
insulin therapy regimen were the two factors associated with good glycemic control after multivariate analysis. A review of criteria for reimbursement
of insulin analogues by the National Health Insurance Fund is necessary in order to rationalize the expenses related to these molecules.


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