Clinical inertia among patients with type 2 diabetes mellitus treated with DPP-4i and/or SGLT-2i
Open accessAbstract
Objectives Failure to intensify treatment of patients with type 2 diabetes (T2D) in a timely manner is a common challenge. If newer oral anti-diabetic drugs (NOADs) such as dipeptidyl peptidase-4 inhibitors (DPP-4i) and sodium/glucose cotransporter 2 inhibitors (SGLT-2i) do not achieve metabolic control, injectable therapy like insulin or glucagon-like Peptide 1 (GLP-1) receptor agonists are required. We investigated the time in poor glycaemic control (PC, HbA1c > 7%, >7.5%, >8%) in adults with T2D treated with DPP-4i/SGLT-2i until treatment intensification with insulin/GLP-1 or until the most recent documented visit. Methods T2D ≥ 18 years were identified from the diabetes patient follow-up registry (DPV), which captures data from diabetes specialist care. Patients with ≥2 documented visits with DPP-4i/SGLT-2i treatment and with the most recent treatment year ≥2015 were included. Results The study population consisted of 4576 patients treated with DPP-4i/SGLT-2i. A subgroup of 1416 patients were intensified with an injectable therapy. Mean time in PC until intensification with insulin/GLP-1 was 16.7 months (HbA1c > 7%), 15.7 and 15.1 months (HbA1c > 7.5%, HbA1c > 8%) in this subgroup, respectively. Mean time in PC until most recent visit was 12.6, 9.9 and 8.4 months in the subgroup of patients without treatment intensification. Conclusions Even with NOADs, a substantial proportion of T2D do not achieve good metabolic control. These findings may be due to individualized target setting for HbA1c, or reluctance of patients and physicians towards injectable therapy. Effective diabetes management strategies are necessary to reduce the risk of adverse outcomes and to increase quality of life in T2D.
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Lanzinger et al. found that the average time in poor glycemic control was 12.6, 9.9, and 8.4 months for HbA1c levels above 7.0%, 7.5%, and 8.0%, respectively.
“Lanzinger et al. [24] found that the average time in poor glycemic control was 12.6, 9.9, and 8.4 months for HbA1c levels above 7.0%, 7.5%, and 8.0%, respectively.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [24]
The Results report 12.6, 9.9, and 8.4 months at the stated HbA1c thresholds, but only for patients without treatment intensification, measured until their most recent visit. The unqualified claim omits that restriction; the Results give different averages for the overall study population. (LLM, conf=0.90)
Experimental — accuracy not yet measuredA longer duration of diabetes is associated with treatment intensification.
“Similarly, Lanzinger et al. [24] reported that a longer duration of diabetes was associated with treatment intensification.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [24]
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References 26 · Cited by 4
Research works printed but not linked: 19
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- Authors
- Lanzinger, S., Schmid, S. M., Welp, R., Zimmermann, A., Fasching, P., Wagner, S., & Holl, R. W.
- Affiliations
- Universität Ulm (DE)
- German Center for Diabetes Research (DE)
- Wilhelminen Hospital (AT)
- Corresponding author
- Lanzinger, S.
- Venue
- Diabetes Research and Clinical Practice
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 146
- Pages
- 162-171
- ISSN
- 0168-8227 (ISSN-L)
- OpenAlex
- W2898486241
- Cited by
- 4
- References
- 26
- Citations by year
- 2023: 3 · 2020: 1
- FWCI
- 0.20
- Type
- journal article
- Language
- en
- Open access
- green
- nbn-resolving.de
- Licence
- Locations
- Diabetes Research and Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- OPen Access Repositorium der Universität Ulm (OPARU) (Ulm University) (submittedVersion, cc-by-nc-nd)
- Universität Ulm, Kommunikations- und Informationszentrum (kiz)
- Funders
- European Foundation for the Study of Diabetes
- Federal Ministry of Education and Research within the German Competence Network Diabetes Mellitus (01GI1106)
- Innovative Medicines Initiative 2 Joint (115797)
- Union’s Horizon 2020 research and innovation programme
- EFPIA
- JDRF
- The Leona M. and Harry B. Helmsley Charitable Trust
- Diabetes and Research on Patient Stratification initiative
- Novo Nordisk A/S
- 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
- type 2 diabetes, clinical inertia, DPP-4 inhibitors, SGLT2 inhibitors, glycemic control, HbA1c, treatment intensification, insulin therapy, GLP-1 receptor agonists, injectable therapy
- MeSH terms
- Aged, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemic Agents, Male, Glucagon-Like Peptide 1, Dipeptidyl-Peptidase IV Inhibitors
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