Consequences of delaying treatment intensification in type 2 diabetes: evidence from a UK database

Watson, Louise; Das, Romita; Farquhar, Ruth; Langerman, Haya; Barnett, Anthony

doi:10.1185/03007995.2016.1157462

Cited by 22 publications

(28 citation statements)

References 24 publications

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“…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%

“…Treatment characteristics varied across studies. Among articles that described therapy before treatment intensification, patients were managed exclusively with oral antidiabetic drugs (OADs) in most cases . The study by Brown et al also included a group of patients managed with non‐pharmacological treatment (ie, diet and exercise exclusively) .…”

Section: Resultsmentioning

confidence: 99%

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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

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

show abstract

“…As seen in previous studies in populations initiating BI, these patients were characterized by elevated HbA1c levels at baseline; a high proportion of patients initiated BI with HbA1c > 9.0%, highlighting a disconnect between real‐world clinical practice and recommendations in clinical guidelines, and indicating a delay in initiating insulin far beyond the point of need. This is of critical concern given the need for tight glycaemic control and/or appropriate treatment intensification to reduce the risk of diabetes‐related complications, to help preserve β‐cell function and to achieve long‐term glycaemic goals . As such, the success of BI‐supported oral therapy is dependent on timely initiation during the natural history of T2DM in the individual patient.…”

Section: Discussionmentioning

confidence: 99%

Glycaemic control and hypoglycaemia burden in patients with type 2 diabetes initiating basal insulin in Europe and the USA

Mauricio

Meneghini

Seufert

et al. 2017

Diabetes Obesity Metabolism

105

109

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AimsTo evaluate short‐ and long‐term glycaemic control and hypoglycaemia incidence in insulin‐naïve patients ≥30 years of age with type 2 diabetes (T2DM) initiating basal insulin (BI) with or without oral anti‐hyperglycaemic drugs (OADs).MethodsThis was an observational, retrospective longitudinal analysis of electronic medical records from 5 European countries and the USA. A multivariable logistic regression model assessed baseline and short‐term (0‐3 months post BI initiation) factors associated with long‐term (3‐24 months) glycaemic control and hypoglycaemia.ResultsOverall, 40 627 patients were included; 20.9% and 27.8% achieved the general HbA1c target of ≤7% at 3 and 24 months post BI initiation, respectively. Failure to achieve HbA1c ≤7% at 3 months was associated with increased risk of failing to achieve target at 24 months (odds ratio [OR], 3.70 [95% CI, 3.41‐4.00]). Over 24 months, 8.9% of patients experienced a recorded hypoglycaemic event. Hypoglycaemia during the initial 3‐month period was associated with longer‐term risk of these events over the ensuing 3 to 24 months (OR, 5.71 [95% CI, 4.67‐6.99]).ConclusionsInitiating BI with or without OADs is associated with short‐ and long‐term suboptimal glycaemic control; the majority of patients fail to achieve HbA1c target ≤7% in the first 3 months, or after 2 years of BI treatment. Treatment response and hypoglycaemia incidence by 3 months post BI initiation are associated with longer‐term glycaemic control and hypoglycaemic risk, respectively. These results support the need for early anti‐hyperglycaemic interventions that more effectively control blood glucose levels without increasing the risk of hypoglycaemia.

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Dose distribution and up‐titration patterns of metformin monotherapy in patients with type 2 diabetes

Iglay

Sawhney²,

et al. 2019

Endocrino Diabet & Metabol

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Aims:To assess the dose distribution among users of metformin monotherapy as well as the patterns of up-titration following initiation of therapy in people with type 2 diabetes mellitus (T2DM). Materials and Methods:This was a retrospective cohort study of adults with T2DM in the United Kingdom (UK). Metformin dose distribution was assessed at 0, 6 and 12 months in people initiating metformin monotherapy (new users) and cross-sectionally in people with ongoing metformin monotherapy (prevalent users). Patterns and predictors of up-titration were also analysed in new users. Dose distributions and treatment patterns were assessed descriptively; predictors of up-titration were determined using multivariable logistic regressions.

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Consequences of delaying treatment intensification in type 2 diabetes: evidence from a UK database

Abstract: Patients who were rapidly intensified achieved a maintained reduction in HbA1c faster than those with delayed intensification or no second-line therapy, despite a higher baseline HbA1c.

Cited by 22 publications

References 24 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

Glycaemic control and hypoglycaemia burden in patients with type 2 diabetes initiating basal insulin in Europe and the USA

Dose distribution and up‐titration patterns of metformin monotherapy in patients with type 2 diabetes

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