The Court of Auditors recommends reforming diabetes care

A rise in diabetes and related spending, but "stagnating health outcomes" : the Court of Auditors called on Tuesday, July 8, for reforms in the treatment of this disease, notably by creating two levels of long-term illness (ALD), and by developing therapeutic education.

Type 2 diabetes, the most common form (92% of cases), is experiencing strong growth linked to aging and the increase in obesity, and this chronic disease is the one "which most affects disadvantaged people," the institution observed in a report published Tuesday .

The Court of Auditors therefore makes six recommendations, mainly with a view to reforming care. Considering it necessary to "consider the reimbursement of a care pathway which would include therapeutic education and physical activity" , it recommends reviewing the ALD system for type 2 diabetes by creating "two levels of recognition, depending on the level of severity and complication" .

At level 1, the exemption from the co-payment would be concentrated on certain preventive care, follow-up examinations and assessments, but open to non-drug therapies for lifestyle changes, currently excluded from standard reimbursement. At level 2, the exemption from the co-payment would still concern all care related to the pathology.

The level of healthcare expenditure attributable to diabetes, generally reimbursed to patients through the ALD system, is also increasing. According to the authors, one of the main reasons for this increase is the aging of the population, which increases the number of patients and the number of those who have complications. Diabetes most often occurs after the age of 45. But "health outcomes are not improving," because the rate of examinations is not improving and hospitalizations for complications are declining only slightly.

"A path" to follow, according to the Court of Auditors, even if it is necessary to "carefully evaluate" the implications concerning the "remaining cost for patients" and "the balance between savings and additional expenses" for Health Insurance.

In 2022, the ALD diabetes covered 3.6 million people—the largest number of insured persons and one of the fastest-growing, the report states. And 3.8 million people were " pharmacologically treated for diabetes in 2023, representing a prevalence of 5.2%, and growing steadily since the early 2000s ," according to the authors.

"The implementation, before any possible drug treatment, of therapies aimed at modifying the patients' lifestyle should constitute the first-line treatment for diabetes," argues the Court, suggesting, among other measures, that from the time of diagnosis a care pathway should be proposed, including therapeutic education, nutrition and adapted physical activity.