Clinical Inertia in People With Type 2 Diabetes

A retrospective cohort study of more than 80,000 people


Abstract

OBJECTIVE To determine time to treatment intensification in people with type 2 diabetes treated with one, two, or three oral antidiabetes drugs (OADs) and associated levels of glycemic control.
RESEARCH DESIGN AND METHODS This was a retrospective cohort study based on 81,573 people with type 2 diabetes in the U.K. Clinical Practice Research Datalink between January 2004 and December 2006, with follow-up until April 2011.
RESULTS In people with HbA1c ≥7.0, ≥7.5, or ≥8.0% (≥53, ≥58, or ≥64 mmol/mol), median time from above HbA1c cutoff to intensification with an additional OAD was 2.9, 1.9, or 1.6 years, respectively, for those taking one OAD and >7.2, >7.2, and >6.9 years for those taking two OADs. Median time to intensification with insulin was >7.1, >6.1, or 6.0 years for those taking one, two, or three OADs. Mean HbA1c at intensification with an OAD or insulin for people taking one, two, or three OADs was 8.7, 9.1, and 9.7%. In patients taking one, two, or three OADs, median time from treatment initiation to intensification with an OAD or insulin exceeded the maximum follow-up time of 7.2 years. The probability of patients with poor glycemic control taking one, two, or three OADs, intensifying at end of follow-up with an OAD, was 21.1–43.6% and with insulin 5.1–12.0%.
CONCLUSIONS There are delays in treatment intensification in people with type 2 diabetes despite suboptimal glycemic control. A substantial proportion of people remain in poor glycemic control for several years before intensification with OADs and insulin.
  • Received February 8, 2013.
  • Accepted May 9, 2013.

I wonder if diet was ever brought into the equation,  given the author affiliations I very much doubt it or maybe it's me being cynical!

Novo Nordisk contributed to the study design, statistical analyses, data interpretation, manuscript preparation, and the decision to submit the manuscript for publication. The authors received editorial support for this study from Watermeadow Medical, which was funded by Novo Nordisk. Dr. Khuni is the recipient of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care grant from the UK National Health Service Research and Development department for the submitted work and has been an advisory board member, received research funding, and been a paid speaker on behalf of Novo Nordisk in the previous 3 years. Dr. Davies has been an advisory board member, received research funding, been a paid speaker, been paid to develop educational programs, and been compensated for travel/accommodation/meeting expenses on behalf of Novo Nordisk in the previous 3 years. Disclosures for the coauthors are listed in the article.

Graham

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