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Therapeutic inertia in patients treated with two or more antidiabetics in primary care: F actors predicting intensification of treatment

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Mata‐Cases, Manel, Franch‐Nadal, Josep, Real, Jordi, Gratacòs, Mònica, López‐Simarro, Flora, Khunti, Kamlesh, Mauricio, Dídac·2018·Diabetes, Obesity and Metabolism
DOI 10.1111/dom.13045
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Abstract

Aims: To determine the patterns and predictors of treatment intensification in patients with type 2 diabetes on ≥2 non‐insulin antidiabetic drugs ( NIAD s) and inadequate glycaemic control in primary care in C atalonia, S pain. Material and Methods: This was a retrospective analysis using electronic medical records from patients with HbA1c ≥ 7% and a first prescription for a new NIAD or insulin recorded from J anuary 2010 to D ecember 2014. Therapeutic inertia was defined as no intensification if HbA1c was ≥8% at baseline or during follow‐up. Time to first intensification was evaluated by time‐to‐event analysis, and factors predicting intensification through a competing‐risk regression model. Results: Among 23 678 patients with HbA1c ≥ 7%, 26.2% were censored without treatment intensification after a median follow up of 4.2 years. Among the 12 730 patients in the subgroup with HbA1c ≥ 8% at baseline or during follow‐up, therapeutic inertia was present in 18.1% of cases. In the overall cohort, mean HbA1c at initiation of insulin and NIAD were 9.4% ± 1.5% and 8.7% ± 1.3%, respectively. Median time to first intensification was 17.1 months in patients with HbA1c 8.0% to 9.9%, and 10.1 months in those with HbA1c > 10%. Variables strongly associated with intensification were HbA1c values 8.0% to 9.9% (subhazard ratio [ SHR ], 1.7; 95% CI , 1.65‐1.78) and >10% ( SHR , 2.5; 95% CI , 2.37‐2.68); diabetes duration ≥20 years ( SHR , 1.25; 95% CI , 1.11‐1.41) and, to a lesser extent, female gender, presence of comorbidities, chronic kidney disease and microvascular complications. Conclusions: Intensification was not undertaken in 1 in 5 patients. Both HbA1c thresholds and time until therapy intensification exceeded current recommendations.

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  • Mata-Cases et al. found a median time for treatment intensification of 17.1 months for HbA1c levels of 8.0-9.9% and 10.1 months for HbA1c levels above 10%.

    “Mata-Cases et al. [35] found a median time for treatment intensification of 17.1 months for HbA1c levels of 8.0–9.9% and 10.1 months for HbA1c levels above 10%.”

    From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [35]

    Section 3.4 reports that median time to intensification decreased as HbA1c increased, and the passage accompanying Figure 1A gives 10.1 months for patients with HbA1c ≥10%. Our copy does not give the claimed 17.1-month median for the 8.0–9.9% group. It also defines the higher group as ≥10%, rather than strictly above 10%. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • A Spanish study showed the lowest clinical inertia.

    “A Spanish study showed the lowest clinical inertia [35].”

    From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [35]

    The study used Catalan primary-care records (Study design and data source; page unavailable), and Results §3.2 reports therapeutic inertia in 18.1% of patients with HbA1c ≥8%. The Discussion compares rates across studies but does not establish that this Spanish study had the lowest rate; the claim omits the HbA1c threshold and patient group. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Treatment intensification is associated with female gender.

    “Mata-Cases et al. [35] reported that treatment intensification was associated with HbA1c of 8.0-9.9% or more than 10%, diabetes duration of ≥20 years, female gender, and presence of a comorbidity.”

    From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [35]

  • Treatment intensification is associated with HbA1c of 8.0-9.9% or more than 10%.

    “Mata-Cases et al. [35] reported that treatment intensification was associated with HbA1c of 8.0-9.9% or more than 10%, diabetes duration of ≥20 years, female gender, and presence of a comorbidity.”

    From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [35]

  • Treatment intensification is associated with diabetes duration of 20 years or more.

    “Mata-Cases et al. [35] reported that treatment intensification was associated with HbA1c of 8.0-9.9% or more than 10%, diabetes duration of ≥20 years, female gender, and presence of a comorbidity.”

    From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [35]

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Cited by

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Authors
Mata‐Cases, M., Franch‐Nadal, J., Real, J., Gratacòs, M., López‐Simarro, F., Khunti, K., & Mauricio, D.
Affiliations
  • Instituto de Salud Carlos III (ES)
  • Universitat Internacional de Catalunya (ES)
  • DAP‐Cat group. Unitat de Suport a la Recerca Barcelona Ciutat Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) Barcelona Spain
  • Institut Català de la Salut (ES)
  • University of Leicester (GB)
ORCID
Venue
Diabetes, Obesity and Metabolism
Publisher
Wiley
Published
2017-07-28
Volume
20
Issue
1
Pages
103-112
ISSN
  • 1462-8902 (ISSN-L)
  • 1463-1326
DOI
10.1111/dom.13045
OpenAlex
W2726236139
Cited by
72
References
3
Citations by year
2026: 1 · 2025: 2 · 2024: 6 · 2023: 10 · 2022: 8 · 2021: 12 · 2020: 18 · 2019: 7 · 2018: 8
FWCI
7.14
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Obesity and Metabolism (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Leicester Research Archive (University of Leicester) (submittedVersion, cc-by-nc)
Funders
Sanofi
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, treatment intensification, non-insulin antidiabetic drugs, insulin initiation, inadequate glycaemic control, HbA1c thresholds, diabetes duration, comorbidities, chronic kidney disease, microvascular complications, primary care
MeSH terms
Aged, Aged, 80 and over, Diabetes Mellitus, Type 2, Drug Therapy, Combination, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Insulin, Male, Practice Patterns, Physicians', Retrospective Studies, Spain, Cohort Studies, Drug Monitoring, Practice Guidelines as Topic, Drug Resistance, Multiple, Electronic Prescribing, Electronic Health Records, Physicians, Primary Care

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