Therapeutic inertia in patients with type 2 diabetes treated with non-insulin agents.

Autores de INCLIVA

• 

  Javier Ampudia Blasco

  Autor

• Ana Palanca Palanca

  Autor

• Jose Luis Trillo Mata

  Autor

• 

  Jorge Navarro Perez

  Autor

• 

  Jose Tomas Real Collado

  Autor

Grupos y Plataformas de I+D+i

• Grupo de investigación cardiometabólica en atención primaria

  

  Leading Researcher

  Jorge Navarro Perez

• Grupo de Investigación sobre Riesgo Cardiometabólico y Diabetes

  

  Leading Researcher

  Sergio Martinez Hervas

Abstract

AIMS: To analyze therapeutic inertia in type 2 diabetes (T2D) subjects with suboptimal glycemic control and treated with =2 non-insulin antidiabetic agents in a primary care setting. METHODS: A retrospective study was conducted using electronic medical records from subjects with HbA1c =7.0% (=53?mmol/mol). Therapeutic inertia was defined as the absence of treatment intensification despite suboptimal glycemic control where intensification should have been implemented (HbA1c =7.5% [=58?mmol/mol]). Time to the first intensification with non-insulin antidiabetic agent or insulin and HbA1c values at the time of intensification were evaluated by competing risk analysis. RESULTS: 2652 adults with T2D and HbA1c =7.0% (=53?mmol/mol) were included. During the 4-year follow-up, among 1628 individuals with HbA1c =7.5% [=58?mmol/mol], therapeutic inertia was present in 42.9% of cases. Median time to intensification was 14.5?months (IQR(25)(-)(75), 4-24?months). In this subgroup, 72.7% of subjects initiated non-insulin agents whereas 27.3% initiated insulin. Mean HbA1c values at initiation of treatment intensification were 8.6% (70?mmol/mol) and 9.2% (77?mmol/mol), respectively. CONCLUSIONS: Therapeutic inertia occurred in over 40% of subjects. Treatment intensification took longer and was performed at higher HbA1c than recommended in clinical guidelines. Reducing therapeutic inertia is a priority to achieve therapeutic goals and prevent chronic complications in T2D.

Copyright © 2020 Elsevier Inc. All rights reserved.

Keywords

• Clinical inertia; Glycemic control; Therapeutic inertia; Treatment intensification; Type 2 diabetes