Clinical inertia in the treatment of hyperglycemia in type 2 diabetes patients in primary care

Mata-Cases, Manel; Benito-Badorrey, Belén; Roura-Olmeda, Pilar; Franch-Nadal, Josep; Vilaubí, Josep Maria Pepió; Sáez, Marc; Coll‐de‐Tuero, Gabriel

doi:10.1185/03007995.2013.833089

Cited by 60 publications

(60 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Out of 7698 combined search results, 53 articles were identified that reported at least 1 measure of therapeutic inertia in the management of hyperglycaemia in individuals with type 2 diabetes . The main reasons for exclusion of publications other than duplicates and those covering irrelevant topics were that they reported non‐original research (eg, editorials, letters, comments and guidelines) or they were congress abstracts (Figure ).…”

Section: Resultsmentioning

confidence: 99%

“…Articles mainly reported data from cohort studies, using data from medical records or chart reviews, or from claims, clinical research or administrative databases. Four articles reported results from cross‐sectional studies, and the data were collected using provider questionnaires or surveys . A single publication reported results from a randomized clinical trial that evaluated the impact of physician education on the management of individuals with type 2 diabetes, and another provided results from a post hoc analysis of a randomized controlled trial …”

Section: Resultsmentioning

confidence: 99%

“…Patients were managed by primary care providers in 21 studies, by both primary care providers and secondary care specialists in 6 studies, and by secondary care specialists alone in 1 study . The healthcare providers responsible for patient care were not described in 25 studies .…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: A systematic review

Khunti

Gomes

Pocock

et al. 2017

Diabetes Obesity Metabolism

284

264

View full text Add to dashboard Cite

AimsTherapeutic inertia, defined as the failure to initiate or intensify therapy in a timely manner according to evidence‐based clinical guidelines, is a key reason for uncontrolled hyperglycaemia in patients with type 2 diabetes. The aims of this systematic review were to identify how therapeutic inertia in the management of hyperglycaemia was measured and to assess its extent over the past decade.Materials and MethodsSystematic searches for articles published from January 1, 2004 to August 1, 2016 were conducted in MEDLINE and Embase. Two researchers independently screened all of the titles and abstracts, and the full texts of publications deemed relevant. Data were extracted by a single researcher using a standardized data extraction form.ResultsThe final selection for the review included 53 articles. Measurements used to assess therapeutic inertia varied across studies, making comparisons difficult. Data from low‐ to middle‐income countries were scarce. In most studies, the median time to treatment intensification after a glycated haemoglobin (HbA1c) measurement above target was more than 1 year (range 0.3 to >7.2 years). Therapeutic inertia increased as the number of antidiabetic drugs rose and decreased with increasing HbA1c levels. Data were mainly available from Western countries. Diversity of inertia measures precluded meta‐analysis.ConclusionsTherapeutic inertia in the management of hyperglycaemia in patients with type 2 diabetes is a major concern. This is well documented in Western countries, but corresponding data are urgently needed in low‐ and middle‐income countries, in view of their high prevalence of type 2 diabetes.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: A systematic review

Khunti

Gomes

Pocock

et al. 2017

Diabetes Obesity Metabolism

284

264

View full text Add to dashboard Cite

show abstract

“…These results could be explained by a delay in the intensification of treatment, or so‐called “therapeutic inertia”, and the fact that therapeutic changes are sometimes introduced after several years of uncontrolled HbA1c . In the setting of primary care in Catalonia, therapeutic inertia has been observed in 30%–40% of patients with HbA1c >7% (>53 mmol/mol) and treatment modifications are made when HbA1c levels are 1.4 points above the recommended target value of 7% (53 mmol/mol) …”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of type 2 diabetic patients on basal insulin therapy with adequate fasting glucose control who do not achieve HbA1c targets

Mata-Cases

Mauricio

Franch-Nadal

2016

Journal of Diabetes

Self Cite

View full text Add to dashboard Cite

Background: The aim of the present study was to determine the clinical characteristics of patients with type 2 diabetes mellitus (T2DM) treated with basal insulin who achieved an adequate fasting plasma glucose (FPG) level (<130 mg/dL), but were unable to achieve the HbA1c target (<7%; <53 mmol/mol). Methods: A cross-sectional study was performed on T2DM patients aged 31-90 years treated with basal insulin registered in the SIDIAP Q primary healthcare electronic database during 2010. Results: In 2010, of a population of 126 811 T2DM subjects, 9899 were treated with basal insulin (neutral protamine Hagedorn [NPH], detemir, or glargine). Of these, 23.5% (n = 2322) achieved optimal FPG control levels (<130 mg/dL) but an inadequate HbA1c target (>7%). Mean HbA1c values in the contolled and uncontrolled groups were 8.15% (65.6 mmol/mol) and 6.31% (45.5 mmol/mol), respectively. Patients with controlled FPG but uncontrolled HbA1c had longer T2DM duration (11.6 vs 9.9 years), higher systolic blood pressure (138.2 vs 136.3 mmHg) and low-density lipoprotein cholesterol (104 vs 99 mg /dL), and a higher prevalence of retinopathy (24.8% vs 18.2%) than patients (17.8%) with optimal control of both glycemic targets (P < 0.05). Multivariate analysis showed that inadequate glycemic control was positively related only to younger age. Conclusion: One-quarter of T2DM patients treated with basal insulin have difficulties attaining the recommended HbA1c goal despite adequate FPG levels. As some guidelines state, healthcare professionals should focus on PPG to identify and intensify treatment to control prandial glucose excursions in these patients.

show abstract

“…This clinical inertia affects approximately one-third of patients with type 2 diabetes, and this failure of PCPs to act, coupled with patients’ prolonged exposure to hyperglycemia, leads to a higher risk of chronic complications and mortality[28]. …”

Section: Discussionmentioning

confidence: 99%

Barriers that practitioners face when initiating insulin therapy in general practice settings and how they can be overcome

Rsheed¹,

Chenoweth²

2017

WJD

View full text Add to dashboard Cite

AIMTo explore primary care physicians’ perspectives on possible barriers to the use of insulin.METHODSThis systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight electronic databases were searched (between January 1, 1994 and August 31, 2014) for relevant studies. A search for grey literature and a review of the references in the retrieved studies were also conducted. Studies that focused on healthcare providers’ perspectives on possible barriers to insulin initiation with type 2 diabetic patients were included, as well as articles suggesting solutions for these barriers. Review articles and studies that only considered patients’ perspectives were excluded.RESULTSA total of 19 studies met the inclusion criteria and were therefore included in this study: 10 of these studies used qualitative methods, 8 used quantitative methods and 1 used mixed methods. Studies included a range of different health care settings. The findings are reported under four broad categories: The perceptions of primary care physicians about the barriers to initiate insulin therapy for type 2 diabetes patients, how primary care physicians assess patients prior to initiating insulin, professional roles and possible solutions to overcome these barriers. The barriers described were many and covered doctor, patient, system and technological aspects. Interventions that focused on doctor training and support, or IT-based decision support were few, and did not result in significant improvement.CONCLUSIONPrimary care physicians’ known delay in insulin initiation is multifactorial. Published reports of attempts to find solutions for these barriers were limited in number.

show abstract

Clinical inertia in the treatment of hyperglycemia in type 2 diabetes patients in primary care

Abstract: Clinical inertia affected one third of T2DM patients with poor glycemic control and was greater in patients treated with only lifestyle changes or oral monotherapy. Treatment changes were performed when mean HbA1c values were 1.4 points above therapeutic goals.

Cited by 60 publications

References 23 publications

Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: A systematic review

Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: A systematic review

Clinical characteristics of type 2 diabetic patients on basal insulin therapy with adequate fasting glucose control who do not achieve HbA1c targets

Barriers that practitioners face when initiating insulin therapy in general practice settings and how they can be overcome

Contact Info

Product

Resources

About