Clinical Inertia in Poorly Controlled Type 2 Diabetes Mellitus Patients with Obesity: An Observational Retrospective Study
Open accessAbstract
To evaluate clinical inertia in patients with type 2 diabetes mellitus (T2DM), obesity and poor glycaemic control in routine clinical practice. This was a retrospective, observational study based on the analysis of medical records from the BIG-PAC® database. Subjects who required medical care in 2013 with the following characteristics were enrolled in the study: age ≥ 30 years, diagnosis of T2DM, glycosylated haemoglobin (HbA1c) ≥ 8%, obesity (body mass index [BMI] ≥ 30 kg/m 2 ) and treatment with ≥ 2 oral antidiabetic drugs (OADs). Inertia was evaluated by time (days) to the first intensification during the period while HbA1c levels were ≥ 8% and percentage of patients whose treatment was not intensified at 6 months, 1, 2 and 3 years and the end of follow-up. The minimum length of follow-up was 4 years. Descriptive analyses and Kaplan–Meier survival curves were performed. A total of 13,824 patients with T2DM receiving ≥ 2 OADs were identified; of these 2709 (19.6%) had HbA1c ≥ 8% and BMI ≥ 30 kg/m 2 , thus fulfilling the inclusion criteria. Of these 2709 patients, the mean age was 65.5 (standard deviation [SD] 12.0) years; 54.9% were male, mean HbA1c level was 9.2% (SD 1.3%); mean BMI was 32.1 (SD 0.9) kg/m 2 ; and mean time from diagnosis was 8.2 (SD 3.0) years. HbA1c remained ≥ 8% for a median of 440 (95% confidence interval [CI] 421–459) days. The median time to first intensification was 456 (95% CI 429–483) days. No intensification had occurred in 77.8, 59.5, 41.5, 28.1 and 22.4% of patients at 6 months, 1, 2, 3 years and the end of follow-up, respectively. The patients with T2DM analysed in this study had a mean HbA1c of 9.2% at baseline, and this remained at ≥ 8% for > 1 year. The time to the first treatment intensification was longer than that recommended by guidelines. Treatment was not intensified in a large percentage of patients, with almost 60% of patients not receiving intensification at 1 year of follow-up.
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Romera et al. reported a median time to first treatment intensification of 456 days or 15.2 months.
“Similarly, Romera et al. [25] reported a median time to first treatment intensification of 456 days or 15.2 months.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [25]
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Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review
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- Authors
- Romera, I., Díaz, S., Sicras-Mainar, A., López-Simarro, F., Dilla, T., Artime, E., & Reviriego, J.
- Affiliations
- Eli Lilly (Spain) (ES)
- Corresponding author
- Romera, Irene
- Venue
- Diabetes Therapy
- Published
- 2019-12-28
- Volume
- 11
- Issue
- 2
- Pages
- 437-451
- ISSN
- 1869-6953 (ISSN-L)
- 1869-6961
- PMC
- PMC6995792
- OpenAlex
- W2997853913
- Cited by
- 11
- References
- 39
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 2 · 2021: 1 · 2020: 1
- FWCI
- 0.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Diabetes Therapy (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- clinical inertia, type 2 diabetes, obesity, poor glycaemic control, HbA1c, oral antidiabetic drugs, treatment intensification, real-world clinical practice, treatment non-adherence
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