Diabetes Treatment Intensification Delay Associated With Sociodemographic Factors

A senior citizen of african descent goes to the doctor. She is listening intently about the pills that she is going to start taking.
Racial and age-specific disparities may exist in patterns of treatment intensification for patients with type 2 diabetes.

SAN FRANCISCO — Race- and age-specific disparities may exist in patterns of treatment intensification for patients with type 2 diabetes, according to research presented at the American Diabetes Association 79th Scientific Sessions, held June 7 to 11, 2019.

Prior research has found significant delays in intensifying treatment for patients with diabetes in clinical practice, but differences in clinical inertia based on sociodemographic factors are less clear. Researchers used data from the GE Centricity Electronic Medical Record database to identify patients who were receiving dual therapy with metformin and 1 other antihyperglycemic agent for ≥12 months. Patients were eligible for inclusion if their therapeutic regimens were further intensified (addition of another oral antihyperglycemic agent or initiation of insulin/glucagon-like peptide-1 receptor agonist) within 2 years after index date and a measurement of glycated hemoglobin (HbA1c) level was recorded within 6 months of intensification.

In total, 991 patients were included (mean age, 57.9 years; 47.4% women). Compared with white patients, black patients were more likely to have higher HbA1c levels at the time of treatment intensification. In addition, older patients were less likely to have treatment intensified at higher HbA1c levels compared with younger patients.

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“Physicians should be aware of the issue of clinical inertia and also note that perhaps it may be more pronounced in these subpopulations,” said Swapnil Rajpathak, MD, DrPH, Executive Director, cardiometabolic area, at the Center for Observational and Real-World Evidence at Merck, and coauthor of the study. “Increasing this awareness may help improve diabetes management.”

“It is also important to be aware that the causes of clinical inertia are multifactorial, occurring at the level of the practitioner, patient and/or healthcare system.”

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Fernandes G, Sawhney B, Hannachi H, et al. Clinical inertia in relation to sociodemographic factors among patients with type 2 diabetes (T2D) in the United States. Presented at: American Diabetes Association 79th Scientific Sessions; June 7-11, 2019; San Francisco, CA. Poster 1496-P.