Addressing Therapeutic Inertia in 2020 and Beyond: A 3-Year Initiative of the American Diabetes Association

Gabbay, Robert A.; Kendall, Debbie; Beebe, Christine; Cuddeback, John K.; Hobbs, Todd; Khan, Naeem; Leal, Sandra; Miller, Eden; Novak, Lucia M.; Rajpathak, Swapnil; Scribner, Paul; Meneghini, Luigi; Khunti, Kamlesh

doi:10.2337/cd20-0053

Cited by 62 publications

(57 citation statements)

References 48 publications

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“…Accordingly, this study aimed to determine the proportions and associated factors of therapeutic inertia of anti-diabetic, anti-hypertensive and lipid-lowering therapies when treatment targets not achieved in adults with T2D at public health clinics in Malaysia. The findings may contribute support to local initiatives in overcoming therapeutic inertia similar to the 3-year Overcoming Therapeutic Inertia initiative in the US [ 28 ].…”

Section: Introductionmentioning

confidence: 79%

Is therapeutic inertia present in hyperglycaemia, hypertension and hypercholesterolaemia management among adults with type 2 diabetes in three health clinics in Malaysia? a retrospective cohort study

Chew

Hussain

Supian³

2021

BMC Fam Pract

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Background Good-quality evidence has shown that early glycaemic, blood pressure and LDL-cholesterol control in people with type 2 diabetes (T2D) leads to better outcomes. In spite of that, diseases control have been inadequate globally, and therapeutic inertia could be one of the main cause. Evidence on therapeutic inertia has been lacking at primary care setting. This retrospective cohort study aimed to determine the proportions of therapeutic inertia when treatment targets of HbA1c, blood pressure and LDL-cholesterol were not achieved in adults with T2D at three public health clinics in Malaysia. Methods The index prescriptions were those that when the annual blood tests were reviewed. Prescriptions of medication were verified, compared to the preceding prescriptions and classified as 1) no change, 2) stepping up and 3) stepping down. The treatment targets were HbA1c < 7.0% (53 mmol/mol), blood pressure (BP) < 140/90 mmHg and LDL-cholesterol < 2.6 mmol/L. Therapeutic inertia was defined as no change in the medication use in the present of not reaching the treatment targets. Descriptive, univariable, multivariable logistic regression and sensitive analyses were conducted. Results A total of 552 cohorts were available for the assessment of therapeutic inertia (78.9% completion rate). The mean (SD) age and diabetes duration were 60.0 (9.9) years and 5.0 (6.0) years, respectively. High therapeutic inertia were observed in oral anti-diabetic (61–72%), anti-hypertensive (34–65%) and lipid-lowering therapies (56–77%), and lesser in insulin (34–52%). Insulin therapeutic inertia was more likely among those with shorter diabetes duration (adjusted OR 0.9, 95% CI 0.87, 0.98). Those who did not achieve treatment targets were less likely to experience therapeutic inertia: HbA1c ≥ 7.0%: adjusted OR 0.10 (0.04, 0.24); BP ≥ 140/90 mmHg: 0.28 (0.16, 0.50); LDL-cholesterol ≥ 2.6 mmol/L: 0.37 (0.22, 0.64). Conclusions Although therapeutic intensifications were more likely in the presence of non-achieved treatment targets but the proportions of therapeutic inertia were high. Possible causes of therapeutic inertia were less of the physician behaviours but might be more of patient-related non-adherence or non-availability of the oral medications. These observations require urgent identification and rectification to improve disease control, avoiding detrimental health implications and costly consequences. Trial registration Number NCT02730754, April 6, 2016.

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Section: Introductionmentioning

confidence: 79%

Is therapeutic inertia present in hyperglycaemia, hypertension and hypercholesterolaemia management among adults with type 2 diabetes in three health clinics in Malaysia? a retrospective cohort study

Chew

Hussain

Supian³

2021

BMC Fam Pract

View full text Add to dashboard Cite

show abstract

“…Accordingly, this study aimed to determine the proportions and associated factors of therapeutic inertia of anti-diabetic, anti-hypertensive and lipid-lowering therapies when treatment targets not achieved in adults with T2D at public health clinics in Malaysia. The ndings may contribute support to local initiatives in overcoming therapeutic inertia similar to the 3-year Overcoming Therapeutic Inertia initiative in the US [27].…”

Section: Introductionmentioning

confidence: 70%

Is Therapeutic Inertia Present in hyperglycaemia, Hypertension and Hypercholesterolaemia Management among Adults with type 2 Diabetes in three Health Clinics in Malaysia? A Retrospective Cohort Study

Chew

Hussain²,

Supian³

2021

Preprint

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Background: Good-quality evidence has shown that early glycaemic, blood pressure and LDL-cholesterol control in people with type 2 diabetes (T2D) leads to better outcomes. In spite of that, diseases control have been inadequate globally, and therapeutic inertia could be one of the main cause. Evidence on therapeutic inertia has been lacking at primary care setting. This retrospective cohort study aimed to determine the proportions of therapeutic inertia when treatment targets of HbA1c, blood pressure and LDL-cholesterol were not achieved in adults with T2D at three public health clinics in Malaysia.Methods: The index prescriptions were those that when the annual blood tests were reviewed. Prescriptions of medication were verified, compared to the preceding prescriptions and classified as 1) no change, 2) stepping up and 3) stepping down. The treatment targets were HbA1c < 7.0% (53 mmol/mol), blood pressure (BP) < 140/90 mmHg and LDL-cholesterol < 2.6 mmol/L. Therapeutic inertia was defined as no change in the medication use in the present of not reaching the treatment targets. Descriptive, univariable, multivariable logistic regression and sensitive analyses were conducted. Results: A total of 552 cohorts were available for the assessment of therapeutic inertia (78.9% completion rate). The mean (SD) age and diabetes duration were 60.0 (9.9) years and 5.0 (6.0) years, respectively. High therapeutic inertia were observed in oral anti-diabetic (61-72%), anti-hypertensive (34-65%) and lipid-lowering therapies (56-77%), and lesser in insulin (34-52%). Insulin therapeutic inertia was more likely among those with shorter diabetes duration (adjusted OR 0.9, 95% CI 0.87, 0.98). Those who did not achieve treatment targets were less likely to experience therapeutic inertia: HbA1c ≥ 7.0%: adjusted OR 0.10 (0.04, 0.24); BP ≥ 140/90 mmHg: 0.28 (0.16, 0.50); LDL-cholesterol ≥ 2.6 mmol/L: 0.37 (0.22, 0.64). Conclusions: Although therapeutic intensifications were more likely in the present of non-achieved treatment targets but the proportions of therapeutic inertia were high. Possible causes of therapeutic inertia were less of the physician behaviours but may be more of patient-related non-adherence or non-availability of the oral medications and these require urgent identification and rectification to improve disease control, avoiding detrimental health implications and costly consequences.

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“…It is even developing user-friendly tools to support decision-making processes, in order to adopt therapeutic choices tailored to patients’ needs. Clinicians’ awareness of newer drugs and their positive effect on CV and renal outcomes, as well as a better knowledge of continuous glucose monitoring, represent a worldwide issue and are some of the practical steps to be addressed by the OTI initiative, as well as the identification of best practices with the constitution of a research team [ 132 ].…”

Section: Future Perspectives For Dkd-related Therapeutical Inertia Managementmentioning

confidence: 99%

Kidney Disease in Diabetic Patients: From Pathophysiology to Pharmacological Aspects with a Focus on Therapeutic Inertia

Gembillo

Ingrasciotta

Crisafulli

et al. 2021

IJMS

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Diabetes mellitus represents a growing concern, both for public economy and global health. In fact, it can lead to insidious macrovascular and microvascular complications, impacting negatively on patients’ quality of life. Diabetic patients often present diabetic kidney disease (DKD), a burdensome complication that can be silent for years. The average time of onset of kidney impairment in diabetic patients is about 7–10 years. The clinical impact of DKD is dangerous not only for the risk of progression to end-stage renal disease and therefore to renal replacement therapies, but also because of the associated increase in cardiovascular events. An early recognition of risk factors for DKD progression can be decisive in decreasing morbidity and mortality. DKD presents patient-related, clinician-related, and system-related issues. All these problems are translated into therapeutic inertia, which is defined as the failure to initiate or intensify therapy on time according to evidence-based clinical guidelines. Therapeutic inertia can be resolved by a multidisciplinary pool of healthcare experts. The timing of intensification of treatment, the transition to the best therapy, and dietetic strategies must be provided by a multidisciplinary team, driving the patients to the glycemic target and delaying or overcoming DKD-related complications. A timely nephrological evaluation can also guarantee adequate information to choose the right renal replacement therapy at the right time in case of renal impairment progression.

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Addressing Therapeutic Inertia in 2020 and Beyond: A 3-Year Initiative of the American Diabetes Association

Cited by 62 publications

References 48 publications

Is therapeutic inertia present in hyperglycaemia, hypertension and hypercholesterolaemia management among adults with type 2 diabetes in three health clinics in Malaysia? a retrospective cohort study

Is therapeutic inertia present in hyperglycaemia, hypertension and hypercholesterolaemia management among adults with type 2 diabetes in three health clinics in Malaysia? a retrospective cohort study

Is Therapeutic Inertia Present in hyperglycaemia, Hypertension and Hypercholesterolaemia Management among Adults with type 2 Diabetes in three Health Clinics in Malaysia? A Retrospective Cohort Study

Kidney Disease in Diabetic Patients: From Pathophysiology to Pharmacological Aspects with a Focus on Therapeutic Inertia

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