A Multicenter Italian Survey on Diabetes Care Units Reveals a Somewhat Slow Attitude in Treatment Guideline Implementation: Are We Dealing With Therapeutic Inertia?

Gentile, Sandro; Ceriello, Antonio; Strollo, Felice; Members, START DIAB Study Group

doi:10.17140/droj-2-127

Cited by 6 publications

(7 citation statements)

References 34 publications

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“…Trained HCPs tested participants for their adherence to the three usual insulin titration protocol rules (see below) using a validated questionnaire that included the following four closed answers: (1) no; (2) yes; (3) yes most of the time; (4) no most of the time. Answers (1) and 4were recorded as ''no;'' the other two answers were recorded as ''yes,'' as previously described [41].…”

Section: Educationmentioning

confidence: 99%

Role of Structured Education in Reducing Lypodistrophy and its Metabolic Complications in Insulin-Treated People with Type 2 Diabetes: A Randomized Multicenter Case–Control Study

Gentile

Guarino²,

Corte

et al. 2021

Diabetes Ther

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Section: Educationmentioning

confidence: 99%

Role of Structured Education in Reducing Lypodistrophy and its Metabolic Complications in Insulin-Treated People with Type 2 Diabetes: A Randomized Multicenter Case–Control Study

Gentile

Guarino²,

Corte

et al. 2021

Diabetes Ther

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“…Percentage of therapy intensification in patients with HBA1c > 8% (addition of an oral hypoglycemic agent or dosage increase for an existing therapy or initiation of insulin treatment) [33,83] Percentage of therapy intensification in patients with HBA1c > 7% [84] Percentage of initiation of insulin treatment in patients with HBa1c > 9% [42] Average time elapsed between type 2 diabetes diagnosis and initiation of insulin treatment in patients with non-target HBa1c [42] Percentage of patients with HBa1c > 7% undergoing basal insulin treatment for 180 days and subjected to the intensification of insulin therapy [43] Difference between the percentage of outpatient visits in which sBP was higher than the target minus the percentage of outpatient visits in which a modification of anti-hypertensive treatment was implemented, either type or dose of treatment, divided by the number of eligible visits. The resulting value is multiplied by the average difference between sBP as measured in all visits and the target value of sBP [85] Percentage of patients with non-target levels of LDL cholesterol and treated with statins, divided by the total number of eligible patients [86] Time (days) elapsed before a therapeutic intervention subsequent to sub-optimal lab test results [87] Percentage of healthcare professionals who prescribe the initiation of insulin therapy to patients with type 2 diabetes and HbA1c at the recommended threshold of 7-7.9% [42] Number of patients without therapy intensification, divided by the total number of patients with HbA1c ≥ 7%, multiplied by 100 [52] Time spent with poor glycemic control (HbA1c 7%, > 7,5%, > 8%) in patients with type 2 diabetes treated with DPP-4i/SGLT-2i until the intensification of treatment with insulin/GLP-1RA [88] Percentage of patients lacking therapy intensification within 180 days from metformin failure [89] through a methodology equated with the use of outcome indicators (Table 3).…”

Section: Referencesmentioning

confidence: 99%

Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: a narrative literature review

Andreozzi

Candido

Corrao

et al. 2020

Diabetol Metab Syndr

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Diabetes mellitus is a chronic disease characterized by high social, economic and health burden, mostly due to the high incidence and morbidity of diabetes complications. Numerous studies have shown that optimizing metabolic control may reduce the risk of micro and macrovascular complications related to the disease, and the algorithms suggest that an appropriate and timely step of care intensification should be proposed after 3 months from the failure to achieve metabolic goals. Nonetheless, many population studies show that glycemic control in diabetic patients is often inadequate. The phenomenon of clinical inertia in diabetology, defined as the failure to start a therapy or its intensification/de-intensification when appropriate, has been studied for almost 20 years, and it is not limited to diabetes care, but also affects other specialties. In the present manuscript, we have documented the issue of inertia in its complexity, assessing its dimensions, its epidemiological weight, and its burden over the effectiveness of care. Our main goal is the identification of the causes of clinical inertia in diabetology, and the quantification of its social and health-related consequences through the adoption of appropriate indicators, in an effort to advance possible solutions and proposals to fight and possibly overcome clinical inertia, thus improving health outcomes and quality of care.

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“…La inercia terapéutica constituye un problema global importante en el tratamiento y control de la Diabetes Mellitus tipo II; Gentile et al, lo define como el retraso de la prescripción de insulina en condiciones indicadas [8], ya sea por razones asociadas al manejo del médico, por una deficiente relación médico-paciente que no resuelve dudas o miedos del paciente, o por inconvenientes en la obtención de la medicación [8][9][10].…”

Section: Discussionunclassified

Frecuencia y factores asociados a la inercia tera¬péutica en inicio de insulinización en pacientes con Diabetes Mellitus II en el Hospital José Carrasco Arteaga, Cuenca, 2018

Torres

Urdiales²

2021

Rev Med HJCA

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BACKGROUND: Diabetes Mellitus II is a global health issue, with no exception in Ecuador. The pharmacological treatment of DM2 is based on a stepped scheme, which varies according to the patients’ needs, the disease course, and the glycaemic control. The delay in the treatment intensification or the insulin initiation, known as therapeutic inertia, is caused by different factors attributable to both the patient and the health care systems, increasing the risk of both micro and macrovascular chronic complications. METHODS: we carried out an observational, cross-sectional, descriptive and correlation study. 422 patients from the Endocrinology and Internal Medicine outpatient clinic of “Hospital José Carrasco Arteaga” in 2018, with DM2 diagnosis, who received two oral antidiabetic drugs as treatment were studied; with the purpose of identifying the frequency and associated factors with therapeutic inertia in these patients. Data was collected from medical records in a form designed for this study. The data analysis was made in the SPSS v.25 software, applying descriptive statistics and correlation statistics with Chi-square test, with a confidence level of 95%. RESULTS: 59.2% of the sample was 65 years or older, 54.7% were women, 46.7% were overweight and 36% were obese. 96.7% had three or more years of diagnosis of the disease, 63.7% had adequate glycaemic control. The most frequent comorbidity was hypertension, which occurred in 61.6% patients. 87% were using Metformin plus Glibenclamide as treatment. 86.3% were receiving their current treatment for more than three months. Therapeutic inertia presented in 25.8% of the sample, and of these cases, inertia was related to health personnel in 75.2%. CONCLUSION: therapeutic inertia presented in 25.8% of the sample. Most of the therapeutic inertias were related to the health personnel. No significant statistically association was found between the occurrence of therapeutic inertia with age, sex, educational level, comorbidities, nutritional status or years of evolution of DMII.

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A Multicenter Italian Survey on Diabetes Care Units Reveals a Somewhat Slow Attitude in Treatment Guideline Implementation: Are We Dealing With Therapeutic Inertia?

Cited by 6 publications

References 34 publications

Role of Structured Education in Reducing Lypodistrophy and its Metabolic Complications in Insulin-Treated People with Type 2 Diabetes: A Randomized Multicenter Case–Control Study

Role of Structured Education in Reducing Lypodistrophy and its Metabolic Complications in Insulin-Treated People with Type 2 Diabetes: A Randomized Multicenter Case–Control Study

Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: a narrative literature review

Frecuencia y factores asociados a la inercia tera¬péutica en inicio de insulinización en pacientes con Diabetes Mellitus II en el Hospital José Carrasco Arteaga, Cuenca, 2018

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