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.

Reference

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