Degree of control and delayed intensification of antihyperglycaemic treatment in type 2 diabetes mellitus patients in primary care in Spain

Conthe, P.; Mata, Manuel L. de la; Orozco, D.; Pajuelo, Francisco de Miguel; Barreto, Carmen Sofía; Anaya, Silvia Fernández; Gomis, Ramón

doi:10.1016/j.diabres.2010.10.002

Cited by 30 publications

(24 citation statements)

References 17 publications

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“…Out of 7698 combined search results, 53 articles were identified that reported at least 1 measure of therapeutic inertia in the management of hyperglycaemia in individuals with type 2 diabetes . The main reasons for exclusion of publications other than duplicates and those covering irrelevant topics were that they reported non‐original research (eg, editorials, letters, comments and guidelines) or they were congress abstracts (Figure ).…”

Section: Resultsmentioning

confidence: 99%

Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: A systematic review

Khunti

Gomes

Pocock

et al. 2017

Diabetes Obesity Metabolism

297

264

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AimsTherapeutic inertia, defined as the failure to initiate or intensify therapy in a timely manner according to evidence‐based clinical guidelines, is a key reason for uncontrolled hyperglycaemia in patients with type 2 diabetes. The aims of this systematic review were to identify how therapeutic inertia in the management of hyperglycaemia was measured and to assess its extent over the past decade.Materials and MethodsSystematic searches for articles published from January 1, 2004 to August 1, 2016 were conducted in MEDLINE and Embase. Two researchers independently screened all of the titles and abstracts, and the full texts of publications deemed relevant. Data were extracted by a single researcher using a standardized data extraction form.ResultsThe final selection for the review included 53 articles. Measurements used to assess therapeutic inertia varied across studies, making comparisons difficult. Data from low‐ to middle‐income countries were scarce. In most studies, the median time to treatment intensification after a glycated haemoglobin (HbA1c) measurement above target was more than 1 year (range 0.3 to >7.2 years). Therapeutic inertia increased as the number of antidiabetic drugs rose and decreased with increasing HbA1c levels. Data were mainly available from Western countries. Diversity of inertia measures precluded meta‐analysis.ConclusionsTherapeutic inertia in the management of hyperglycaemia in patients with type 2 diabetes is a major concern. This is well documented in Western countries, but corresponding data are urgently needed in low‐ and middle‐income countries, in view of their high prevalence of type 2 diabetes.

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Section: Resultsmentioning

confidence: 99%

Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: A systematic review

Khunti

Gomes

Pocock

et al. 2017

Diabetes Obesity Metabolism

297

264

View full text Add to dashboard Cite

show abstract

“…These patients had approximately double the prevalence rates for nephropathy, ischemic heart disease, and cerebrovascular disease and nearly threefold the prevalence of retinopathy, severe renal disease, and peripheral vascular disease compared with rates reported in other Spanish studies that included T2DM subjects . These results could be explained by a delay in the intensification of treatment, or so‐called “therapeutic inertia”, and the fact that therapeutic changes are sometimes introduced after several years of uncontrolled HbA1c . In the setting of primary care in Catalonia, therapeutic inertia has been observed in 30%–40% of patients with HbA1c >7% (>53 mmol/mol) and treatment modifications are made when HbA1c levels are 1.4 points above the recommended target value of 7% (53 mmol/mol) …”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of type 2 diabetic patients on basal insulin therapy with adequate fasting glucose control who do not achieve HbA1c targets

Mata-Cases

Mauricio

Franch-Nadal

2016

Journal of Diabetes

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Background: The aim of the present study was to determine the clinical characteristics of patients with type 2 diabetes mellitus (T2DM) treated with basal insulin who achieved an adequate fasting plasma glucose (FPG) level (<130 mg/dL), but were unable to achieve the HbA1c target (<7%; <53 mmol/mol). Methods: A cross-sectional study was performed on T2DM patients aged 31-90 years treated with basal insulin registered in the SIDIAP Q primary healthcare electronic database during 2010. Results: In 2010, of a population of 126 811 T2DM subjects, 9899 were treated with basal insulin (neutral protamine Hagedorn [NPH], detemir, or glargine). Of these, 23.5% (n = 2322) achieved optimal FPG control levels (<130 mg/dL) but an inadequate HbA1c target (>7%). Mean HbA1c values in the contolled and uncontrolled groups were 8.15% (65.6 mmol/mol) and 6.31% (45.5 mmol/mol), respectively. Patients with controlled FPG but uncontrolled HbA1c had longer T2DM duration (11.6 vs 9.9 years), higher systolic blood pressure (138.2 vs 136.3 mmHg) and low-density lipoprotein cholesterol (104 vs 99 mg /dL), and a higher prevalence of retinopathy (24.8% vs 18.2%) than patients (17.8%) with optimal control of both glycemic targets (P < 0.05). Multivariate analysis showed that inadequate glycemic control was positively related only to younger age. Conclusion: One-quarter of T2DM patients treated with basal insulin have difficulties attaining the recommended HbA1c goal despite adequate FPG levels. As some guidelines state, healthcare professionals should focus on PPG to identify and intensify treatment to control prandial glucose excursions in these patients.

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“…Tambié n se observa una elevada utilizació n de estatinas (76,6% de los pacientes dislipidé micos), siendo estas cifras má s altas que las publicadas en un estudio realizado en nuestro país (59,2%) 22 . Destaca el elevado porcentaje de incumplimiento en la toma de fibratos por parte de las mujeres (60,0%), aunque este resultado es poco representativo ya que solo 5 mujeres estaban en tratamiento con fibratos.…”

Section: Discusió Nunclassified

Inercia y cumplimiento terapéutico en pacientes con diabetes mellitus tipo 2 en atención primaria

et al. 2012

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Degree of control and delayed intensification of antihyperglycaemic treatment in type 2 diabetes mellitus patients in primary care in Spain

Cited by 30 publications

References 17 publications

Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: A systematic review

Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: A systematic review

Clinical characteristics of type 2 diabetic patients on basal insulin therapy with adequate fasting glucose control who do not achieve HbA1c targets

Inercia y cumplimiento terapéutico en pacientes con diabetes mellitus tipo 2 en atención primaria

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