Therapeutic inertia in type 2 diabetes: Insights from the PANORAMA study in France
Abstract
"Therapeutic inertia" is usually defined as the failure to change or uptitrate treatment strategy when a disease is uncontrolled. In patients with type 2 diabetes (T2D) this may occur with antidiabetes treatments and/or treatment for various cardiovascular risk factors. The PANORAMA study (NCT00916513) compared individual HbA(1c) targets and actual HbA(1c) levels in 5817 patients with T2D in nine European countries, and investigated the reasons why therapeutic choices made by physicians sometimes differ from expert guidelines for this disease. Thus it provides an insight into therapeutic inertia, a fashionable paradigm which can be challenged. This article reports data specifically from the French cohort of patients (n=759). We will try to demonstrate that criticising physicians for not strictly applying the expert T2D guidelines would not be beneficial as the clinical background for this apparent therapeutic inertia is complex. It appears that it may be more clinically relevant and useful to understand the reasons why the therapeutic choice made by the physician-patient partnership can sometimes differ from guidelines. This pragmatic approach would not detract from the need to develop and implement expert guidelines as it is essential to have benchmarks to assess temporal trends of quality of healthcare delivered to patients with T2D at the national level. However, these treatment targets must be put into perspective for clinical practice. Following the Action to Control Car…
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Reasons for non-intensification include therapeutic failure, poor adherence to lifestyle modifications, poor compliance to medications, patient reluctance to intensify treatment, fear of side effects, poor self-monitoring, and cost.
“Reasons for non-intensification include therapeutic failure, poor adherence to lifestyle modifications, poor compliance to medications, patient reluctance to intensify treatment, fear of side effects (such as hypoglycemia, gastrointestinal disturbance, oedema, or weight gain), poor self-monitoring, and cost [37].”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [37]
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- Authors
- Simon, D.
- Affiliations
- Inserm (FR)
- Corresponding author
- Simon, D.
- ORCID
- Simon, D.
- Venue
- Diabetes & Metabolism
- Publisher
- Elsevier BV
- Published
- 2012-03
- Volume
- 38
- Pages
- S47-S52
- ISSN
- 1262-3636 (ISSN-L)
- OpenAlex
- W2035892655
- Cited by
- 23
- References
- 17
- Citations by year
- 2026: 1 · 2025: 4 · 2023: 3 · 2022: 1 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 3 · 2015: 2 · 2014: 1 · 2013: 2
- FWCI
- 1.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- 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 Management and Education
- Keywords
- therapeutic inertia, type 2 diabetes, HbA1c targets, treatment intensification, physician adherence to guidelines, physician-patient partnership, diabetes treatment, cardiovascular risk factors, diabetes care quality, French patients, ACCORD trial, glycemic control, temporal trends in care
- MeSH terms
- Attitude of Health Personnel, Blood Glucose, Cardiovascular Diseases, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Drug Administration Schedule, Europe, Female, France, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Male, Surveys and Questionnaires, Risk Factors, Cohort Studies, Guideline Adherence
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