Examining Therapeutic Inertia in Type 2 Diabetes

HealthDay News — Therapeutic inertia occurs in 19.1% of patients with type 2 diabetes with HbA1c ≥8% on 2 or more non-insulin antidiabetic drugs (NIADs), according to a study published online in Diabetes, Obesity and Metabolism.

Manel Mata-Cases, MD, PhD, from the Institut Universitari d’Investigació en Atenció Primària Jordi Gol in Barcelona, Spain, and colleagues examined the patterns and predictors of treatment intensification in patients with type 2 diabetes.

The researchers found that 26.2% of the 23,678 patients with HbA1c ≥7% were censored without treatment intensification after a median follow-up of 4.2 years. Therapeutic inertia, defined as no intensification if Hba1c was ≥8% at baseline or during follow-up, was seen in 18.1% of the 12,730 patients with HbA1c of ≥8% at baseline or during follow-up. The mean HbA1c values at initiation of insulin and NIAD were 9.4%±1.5% and 8.7%±1.3%, respectively, in the overall cohort. The median time to first intensification was 17.1 and 10.1 months in patients with HbA1c 8% to 9.9% and >10% percent, respectively. HbA1c values 8% to 9.9% and >10% and diabetes duration ≥20 years were variables strongly associated with intensification (subhazard ratios, 1.7, 2.5, and 1.25, respectively).

“Both the HbA1c thresholds and the time until therapy intensification exceeded current recommendations,” the authors write.

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Mata-cases M, Franch-Nadal J, Real J, et al. Therapeutic inertia in patients treated with two or more antidiabetics in primary care: factors predicting intensification of treatment [published online June 28, 2017]. Diabetes Obes Metab. doi:10.1111/dom.13045