(HealthDay News) — Therapeutic inertia occurs in 19.1% of patients with type 2 diabetes with hemoglobin A1c (HbA1c) ≥8% on 2 or more non-insulin antidiabetic drugs (NIADs), according to a study published online in Diabetes, Obesity and Metabolism.
Manel Mata-Cases, MD, PhD, from the Institut Universitari d’Investigació en Atenció Primària Jordi Gol in Barcelona, Spain, and colleagues examined the patterns and predictors of treatment intensification in patients with type 2 diabetes.
The researchers found that 26.2% of the 23,678 patients with HbA1c ≥7% were censored without treatment intensification after a median follow-up of 4.2 years. Therapeutic inertia, defined as no intensification if Hba1c was ≥8% at baseline or during follow-up, was seen in 18.1% of the 12,730 patients with HbA1c of ≥8% at baseline or during follow-up. The mean HbA1c values at initiation of insulin and NIAD were 9.4% ± 1.5% and 8.7% ± 1.3%, respectively, in the overall cohort. The median time to first intensification was 17.1 and 10.1 months in patients with HbA1c 8.0% to 9.9% and >10%, respectively. HbA1c values 8.0% to 9.9% and >10% and diabetes duration ≥20 years were variables strongly associated with intensification (subhazard ratios, 1.7, 2.5, and 1.25, respectively).
“Both the HbA1c thresholds and the time until therapy intensification exceeded current recommendations,” the authors write.
- Mata-Cases M, Franch-Nadal J, Real J, et al. Therapeutic Inertia in Patients Treated With Two or More Antidiabetics in Primary Care: Factors Predicting Intensification of Treatment. Diabetes Obes Metab. 28 June 2017. doi: 10.1111/dom.13045