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

Abstract

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.

Overcoming Therapeutic Inertia as the Achilles’ Heel for Improving Suboptimal Diabetes Care: An Integrative Review

“…for healthcare professionals to work collaboratively and effectively [40,41], and insufficient availability and accessibility of medications and related services [42].…”

“…To overcome TI at the healthcare system level will require policy decisions such as ensuring the availability of all types of antidiabetic medications [40]. This includes having these medications accessible for prescription by different levels of physicians and healthcare professionals, while not being hindered by overrestrictive procedures for newer and more costly medications that have fewer side effects, especially in a healthcare system that subsidises the cost of medications [41]. In addition, this will require empowered nurses, diabetes educators, and pharmacists who could provide timely professional support for medication use [23].…”

Examination of Electrolyte Replacements in the ICU Utilizing MIMIC-III Dataset Demonstrates Redundant Replacement Patterns

“…This does not come as a surprise, as the medical decision-making process is often rooted in several variables, and the intricacies are often not accessible to the decision-making individual. Cultural inertia is often linked to the continuation of medical treatment, even if no evidence of support is present [48,49].…”

Edukasi Peningkatan Pengetahuan Pencegahan Hipertensi Melalui Kombinasi Terapi Autogenik, Relaksasi Otot Progresif dan Terapi Musik (Auto-Resik) di Desa Kemutug Kidul

“…Hal ini dilakukan untuk mengetahui tekanan darah warga. Individu dapat dikatakan terdiagnosis hipertensi jika tekanan darah sitolik pada level 140 mmHg atau lebih dan tekanan darah diastolik pada level 90 mmHg atau lebih (Chew et al, 2021).…”