They are more than 3.8 million in France to live with diabetes, the majority of whom suffer from type 2, often linked to age, overweight and living conditions. And the figures explode: this pathology cost 10.2 billion euros to health insurance in 2023, or 5.3 % of its total expenses. A charge deemed poorly optimized, especially since the state of health of patients does not improve. It is in this context that the Court of Auditors published a shock report, calling for a deep reform of the system. Several recommendations have been issued.
Two ALD levels for better suitable management
The envisaged reform tackles the very structure of care, in particular to the long -term affection system (ALD), which currently allows total exemption from medical costs. The Court recommends the creation of two distinct levels of ALD.
- Level 1: Reserved for cases of Diabetes without complication. He would open up to a targeted reimbursement of health assessments, dietetic advice, adapted physical activity and therapeutic education, in order to help patients modify their lifestyle before the appearance of complications.
- Level 2 : intended for more serious or advanced casethis level would maintain full management, without change for the patients concerned.
This differentiation would both limit unnecessary costs and better support patients according to the severity of their situation. An important turn, when you know that today, all 2 -type diabetics benefit from identical treatment, whether healthy or not.
Prevention and screening: measures from the diagnosis
Another alarming observation: 30 % of people newly diagnosed in 2021 were then that they already had complications. The observation is clear: the location is too late and the prevention actions too little sustained.
To compensate for this, the report recommends
- The strengthening of targeted screening, in particular thanks to the “My prevention assessment” system, generalized in 2024 for those over 45;
- The implementation of a personalized course from the diagnosis, including a complete offer: nutritional advice, supervised physical activity, educational support. All with refunded care for patients concerned.
The objective is clear: to avoid the worsening of the disease at all costs and delay, even remove, the need for heavy drug treatment.
Direct action on social and food inequalities
Finally, behind the figures hide glaring disparities. Type 2 diabetes more severely affects the most precarious populations: the risk is multiplied by 2.8 in the 10 % of the most modest French people. The report therefore calls for acting upstream, on the food environment and living conditions.
The Court recommends:
- Better advertising regulation around ultra-transformed products;
- A strengthening of the Nutri-Score, currently still not very restrictive;
- An extension of the tax on sugary drinks, in order to reduce their consumption;
- And above all, better access to healthy food for everyone, via proactive and structured public policies.
The ambition displayed is to reduce health inequalities from their origin, rather than simply compensate for their medical consequences. For the moment, however, these proposals are being studied, but no specific calendar has been announced either by the government or by health insurance.