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Clinical inertia with regard to intensifying therapy in people with type 2 diabetes treated with basal insulin

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Khunti, K., Nikolajsen, A., Thorsted, B. L., Andersen, M., Davies, M. J., Paul, S. K.·2016·Diabetes, Obesity and Metabolism
DOI 10.1111/dom.12626PMC PMC5067688
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Abstract

Aim: To investigate whether clinical inertia, the failure to intensify treatment regimens when required, exists in people with type 2 diabetes treated with basal insulin. Methods: This was a retrospective cohort study involving patients with type 2 diabetes in the UK C linical Practice Research Datalink database between January 2004 and December 2011, with follow‐up until December 2013. Results: A total of 11 696 patients were included in the analysis. Among all patients, 36.5% had their treatment intensified during the study period; of these, the treatment of 50.0, 42.5 and 7.4% was intensified with bolus or premix insulin or glucagon‐like peptide‐1 receptor agonists, respectively. The median time from initiation of basal insulin to treatment intensification was 4.3 years [95% confidence interval ( CI ) 4.1, 4.6]. Among patients clinically eligible for treatment intensification [glycated haemoglobin ( HbA1c ) ≥7.5% (58 mmol/mol)], 30.9% had their treatment regimen intensified. The median time to intensification in this group was 3.7 years (95% CI 3.4, 4.0). Increasing age, duration of diabetes, oral antihyperglycaemic agent usage and Charlson comorbidity index score were associated with a significant delay in the time to intensification (p < 0.05). Among patients with HbA1c ≥7.5% (58 mmol/mol), 32.1% stopped basal insulin therapy. Conclusions: Strategies should be developed to increase the number of patients undergoing therapy intensification and to reduce the delay in intensifying therapy for suitable patients on basal insulin. Initiatives to support patients continuing on insulin are also required.

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  • A longer duration of diabetes is associated with clinical inertia.

    “For example, Khunti et al. [31] reported that a longer duration was associated with clinical inertia, while Mata-Cases et al. [35] reported that diabetes duration ≥ 20 years was associated with treatment intensification.”

    From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [31]

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Authors
Khunti, K., Nikolajsen, A., Thorsted, B. L., Andersen, M., Davies, M. J., & Paul, S. K.
Affiliations
  • University of Leicester (GB)
  • Novo Nordisk (Denmark) (DK)
  • StatGroup ApS Copenhagen Denmark
  • QIMR Berghofer Medical Research Institute (AU)
Corresponding author
Khunti, K.
ORCID
Venue
Diabetes, Obesity and Metabolism
Publisher
Wiley
Published
2016-02-09
Volume
18
Issue
4
Pages
401-409
ISSN
  • 1462-8902 (ISSN-L)
  • 1463-1326
DOI
10.1111/dom.12626
PMC
PMC5067688
OpenAlex
W2226954704
Cited by
256
References
3
Citations by year
2026: 11 · 2025: 12 · 2024: 20 · 2023: 25 · 2022: 15 · 2021: 18 · 2020: 33 · 2019: 40 · 2018: 39 · 2017: 33 · 2016: 10
FWCI
40.88
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Obesity and Metabolism (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, other-oa)
  • Figshare (submittedVersion, cc-by-nc-nd)
  • Leicester Research Archive (University of Leicester) (submittedVersion, cc-by-nc-nd)
Funders
Novo Nordisk
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
clinical inertia, type 2 diabetes, basal insulin, treatment intensification, HbA1c, insulin intensification, GLP-1 receptor agonists, bolus insulin, insulin discontinuation, comorbidities, age, diabetes duration
MeSH terms
Glucagon-Like Peptide-1 Receptor, Glucagon-Like Peptide-1 Receptor Agonists, Aged, Diabetes Mellitus, Type 2, Drug Therapy, Combination, Female, Follow-Up Studies, United Kingdom, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemic Agents, Insulin, Male, Middle Aged, Practice Patterns, Physicians', Retrospective Studies, Risk, Cohort Studies, Proportional Hazards Models, Drug Monitoring, Diabetes Complications, Physicians, Primary Care

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