Does Clinical Inertia Vary By Personalized A1C Goal? A Study of Predictors And Prevalence of Clinical Inertia In A U.S. Managed-Care Setting

Lin, Jay; Zhou, Steve; Wei, Wenhui; Pan, Chunshen; Lingohr-Smith, Melissa; Levin, Philip

doi:10.4158/ep15868.or

Cited by 45 publications

(66 citation statements)

References 27 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%

“…Articles mainly reported data from cohort studies, using data from medical records or chart reviews, or from claims, clinical research or administrative databases. Four articles reported results from cross‐sectional studies, and the data were collected using provider questionnaires or surveys . A single publication reported results from a randomized clinical trial that evaluated the impact of physician education on the management of individuals with type 2 diabetes, and another provided results from a post hoc analysis of a randomized controlled trial …”

Section: Resultsmentioning

confidence: 99%

“…Patients were managed by primary care providers in 21 studies, by both primary care providers and secondary care specialists in 6 studies, and by secondary care specialists alone in 1 study . The healthcare providers responsible for patient care were not described in 25 studies . Treatment characteristics varied across studies.…”

Section: Resultsmentioning

confidence: 99%

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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%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

“…Clinical inertia has been postulated to be the main reason underlying the low prevalence of multitarget control. Clinical inertia refers to a failure or reluctance to initiate or intensify therapies when clinically indicated . The causes for clinical inertia can be complex and multifactorial involving both clinician and patient barriers .…”

Section: Discussionmentioning

confidence: 99%

“…Clinical inertia refers to a failure or reluctance to initiate or intensify therapies when clinically indicated . The causes for clinical inertia can be complex and multifactorial involving both clinician and patient barriers . At the clinician level, barriers include time constraints for consultation, concern about the potential risk of harm, and lack of information and training needed to achieve therapeutic goals.…”

Section: Discussionmentioning

confidence: 99%

Effect of Multifactorial Treatment Targets and Relative Importance of Hemoglobin A1c, Blood Pressure, and Low‐Density Lipoprotein‐Cholesterol on Cardiovascular Diseases in Chinese Primary Care Patients With Type 2 Diabetes Mellitus: A Population‐Based Retrospective Cohort Study

Wan

Fung

et al. 2017

JAHA

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BackgroundThe relative effect of hemoglobin A1c, blood pressure, and low‐density lipoprotein‐cholesterol (LDL‐C) (“ABC” factors) on the prevention of cardiovascular diseases (CVD) among patients with type 2 diabetes mellitus is poorly understood. This study aimed to evaluate the association of key clinical parameters on CVD risk using a multifactorial optimal control approach in Chinese primary care patients with type 2 diabetes mellitus.Methods and ResultsA population‐based retrospective cohort study was conducted on 144 271 Chinese type 2 diabetes mellitus primary care patients, aged 18 to 79 and without prior clinical diagnosis of CVD in 2008–2011. Cox regressions were conducted to examine the association between the combinations of ABC targets (hemoglobin A1c <7%, blood pressure <130/90 mm Hg, and LDL‐C <2.6 mmol/L) and risks of CVD (overall), coronary heart disease, stroke, and heart failure. Achieving more ABC targets incrementally reduced the incidence of total CVD and individual disease including coronary heart disease, stroke, and heart failure, irrespective of other patient characteristics. Compared with suboptimal control in all ABC levels, achieving any 1, 2, and all 3 ABC targets reduced the relative risk of CVD by 13% to 42%, 31% to 52%, and 55%, respectively. Among those achieving only 1 ABC target, LDL‐C reduction was associated with the greatest CVD risk reduction (42%), followed by blood pressure reduction (18%), and hemoglobin A1c reduction (13%).ConclusionsTo achieve the greatest risk reduction for the incidence of CVD, the ultimate goal of treatment should be to achieve target control of hemoglobin A1c, blood pressure, and LDL‐C. If it is not possible to achieve all 3 targets, efforts should be prioritized on treating the LDL‐C to minimize CVD risk.

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Improved glycaemic control and lower hypoglycaemia risk with reduced prior oral antidiabetes drug therapy in patients with type 2 diabetes treated with insulin glargine 300 U/mL

Dailey

Reid

White

et al. 2018

Endocrino Diabet & Metabol

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Summary Aims Data from the EDITION 3 randomized study and the Clinformatics claims database were analysed to determine whether insulin glargine 300 U/mL (Gla‐300) could provide insulin‐naive patients with type 2 diabetes (T2D) on oral antidiabetes drugs (OADs) with reductions in prior OAD therapy without compromising glycaemic control, and while preserving its known low incidence of hypoglycaemia compared with insulin glargine 100 U/mL (Gla‐100). Methods Patient‐level data from EDITION 3 and de‐identified data from the Clinformatics real‐world claims database were analysed. Results At baseline, 70% of patients in EDITION 3 were on a background of ≥2 OADs. Among the 435 and 437 patients who initiated basal insulin with Gla‐300 and Gla‐100, respectively, at Month 6, 336 (77%) and 338 (77%) were using ≤1 OAD. Adding Gla‐300 or Gla‐100 similarly allowed for a reduction in background OAD medication in the Clinformatics dataset (N = 6430), such that, at 6 months postbasal insulin initiation, 14% of patients were no longer taking any OADs. In the analysis of the EDITION 3 study, reduction in OAD burden did not compromise glycaemic benefit, and the low incidence of hypoglycaemia associated with Gla‐300 compared with Gla‐100 was also preserved. Documented symptomatic hypoglycaemia (blood glucose ≤70 mg/dL) occurred in 30.5% vs 41.0% of patients treated with Gla‐300 and Gla‐100, respectively (P = 0.0442). Conclusion Patients with T2D who initiate basal insulin with Gla‐300 could potentially reduce their prior OAD use without compromising glycaemic control and with less hypoglycaemia than with Gla‐100.

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Does Clinical Inertia Vary By Personalized A1C Goal? A Study of Predictors And Prevalence of Clinical Inertia In A U.S. Managed-Care Setting

Cited by 45 publications

References 27 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

Effect of Multifactorial Treatment Targets and Relative Importance of Hemoglobin A1c, Blood Pressure, and Low‐Density Lipoprotein‐Cholesterol on Cardiovascular Diseases in Chinese Primary Care Patients With Type 2 Diabetes Mellitus: A Population‐Based Retrospective Cohort Study

Improved glycaemic control and lower hypoglycaemia risk with reduced prior oral antidiabetes drug therapy in patients with type 2 diabetes treated with insulin glargine 300 U/mL

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