Response to Comment on Khunti et al. Clinical Inertia in People With Type 2 Diabetes: A Retrospective Cohort Study of More Than 80,000 People. Diabetes Care 2013;36:3411–3417
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We would like to thank Esposito et al. (1) for their interest in and comment on our article (2), in particular their recognition of the importance of the study and the significance of our results. Regarding their concern surrounding the definition of clinical inertia, there are several points that we would like to expand upon. First, we acknowledge that individualizing HbA1c targets may be needed for certain patients (e.g., the elderly) for whom balancing good glycemic control against the risk of hypoglycemia is even more important (3). HbA1c targets in treatment guidelines are only a recommendation. However, these clinical guidelines are used by physicians in practice, and as the …
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Khunti et al. reported that the median time between initiation and intensification of treatment with additional OADs was more than seven years among patients on one, two, or three OADs.
“Khunti et al. [20] reported that the median time between initiation and intensification of treatment with additional OADs was more than seven years among patients on one, two, or three OADs.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [20]
The criteria for clinical inertia included poor glycemic control indicated by mean HbA1c above target, failure to initiate or intensify treatment timely when indicated by HbA1c, lack of individualization of treatment goals, failure to initiate or intensify according to evidence-based guidelines, and failure to initiate or intensify therapy when indicated.
“The criteria for clinical inertia included poor glycemic control as indicated by mean HbA1c levels above the recommended target levels [20], failure to initiate or intensify treatment in a timely manner as indicated by a consultation in which treatment change based on HbA1c levels is indicated but does not occur [21], lack of individualization of treatment goals for some patients [22], failure to”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [20]
Cites
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., Peters, A. L., Tsapas, A., Wender, R., & Matthews, D. R. (2012) · Diabetologia · doi:10.1007/s00125-012-2534-0 · Cited by 3,919 · see citing works
Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., Peters, A. L., Tsapas, A., Wender, R., & Matthews, D. R. (2012) · Diabetes Care · doi:10.2337/dc12-0413 · Cited by 3,207 · see citing works
Survival as a function of HbA1c in people with type 2 diabetes: a retrospective cohort study
Currie, C. J., Peters, J. R., Tynan, A., Evans, M., Heine, R. J., Bracco, O. L., Zagar, T., & Poole, C. D. (2010) · The Lancet · doi:10.1016/s0140-6736(09)61969-3 · Cited by 874 · see citing works
Clinical Inertia in People With Type 2 Diabetes
Khunti, K., Wolden, M. L., Thorsted, B. L., Andersen, M., & Davies, M. J. (2013) · Diabetes Care · doi:10.2337/dc13-0331 · Cited by 615 · see citing works
Self-citationShould A1C Targets Be Individualized for All People With Diabetes?
Teoh, H., Home, P., & Leiter, L. A. (2011) · Diabetes Care · doi:10.2337/dc11-s217 · Cited by 20 · see citing works
Esposito, K., Maiorino, M. I., Bellastella, G., & Giugliano, D. (2014) · Diabetes Care · doi:10.2337/dc13-2511 · Cited by 4 · see citing works
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Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review
Almigbal, T. H., Alzarah, S. A., Aljanoubi, F. A., Alhafez, N. A., Aldawsari, M. R., Alghadeer, Z. Y., & Alrasheed, A. A. (2023) · Medicina · doi:10.3390/medicina59010182 · Cited by 58 · see citing works
“The criteria for clinical inertia included poor glycemic control as indicated by mean HbA1c levels above the recommended target levels [20], failure to initiate or intensify treatment in a timely manner as indicated by a consultation in which treatment change based on HbA1c levels is indicated but does not occur [21],…”
BackgroundKhunti, K. K., Vora, J. P., & Davies, M. J. (2014) · Primary care diabetes · doi:10.1016/j.pcd.2013.11.010 · Cited by 14 · see citing works
Self-citationAlrasheed, M. A., Alhadhrami, B. M., Alqarni, A. A., Alghamdi, N. M., Alfurayh, O. A., & Almohammed, O. A. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1929125
- Authors
- Khunti, K., Wolden, M. L., Thorsted, B. L., Andersen, M., & Davies, M. J.
- Affiliations
- University of Leicester (GB)
- Novo Nordisk (Denmark) (DK)
- StatGroup ApS, Copenhagen, Denmark
- Corresponding author
- Khunti, Kamlesh
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2014-04-10
- Volume
- 37
- Issue
- 5
- Pages
- e114-e114
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W1975865544
- Cited by
- 3
- References
- 6
- Citations by year
- 2026: 1 · 2023: 1 · 2014: 1
- FWCI
- 0.27
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- 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
- clinical inertia, type 2 diabetes, HbA1c targets, glycemic control, hypoglycemia risk, individualized glycemic targets, treatment guidelines
- MeSH terms
- Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemic Agents, Male
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