Diabetes Therapy | 2019
Clinical Inertia in Poorly Controlled Type 2 Diabetes Mellitus Patients with Obesity: An Observational Retrospective Study
Abstract
Introduction To evaluate clinical inertia in patients with type 2 diabetes mellitus (T2DM), obesity and poor glycaemic control in routine clinical practice. Methods This was a retrospective, observational study based on the analysis of medical records from the BIG-PAC® database. Subjects who required medical care in 2013 with the following characteristics were enrolled in the study: age ≥\u200930\xa0years, diagnosis of T2DM, glycosylated haemoglobin (HbA1c)\u2009≥\u20098%, obesity (body mass index [BMI] ≥\u200930\xa0kg/m 2 ) and treatment with\u2009≥\u20092 oral antidiabetic drugs (OADs). Inertia was evaluated by time (days) to the first intensification during the period while HbA1c levels were ≥\u20098% and percentage of patients whose treatment was not intensified at 6\xa0months, 1, 2 and 3\xa0years and the end of follow-up. The minimum length of follow-up was 4\xa0years. Descriptive analyses and Kaplan–Meier survival curves were performed. Results A total of 13,824 patients with T2DM receiving ≥\u20092 OADs were identified; of these 2709 (19.6%) had HbA1c\u2009≥\u20098% and BMI\u2009≥\u200930\xa0kg/m 2 , thus fulfilling the inclusion criteria. Of these 2709 patients, the mean age was 65.5 (standard deviation [SD] 12.0) years; 54.9% were male, mean HbA1c level was 9.2% (SD 1.3%); mean BMI was 32.1 (SD 0.9)\xa0kg/m 2 ; and mean time from diagnosis was 8.2 (SD 3.0) years. HbA1c remained ≥\u20098% for a median of 440 (95% confidence interval [CI] 421–459) days. The median time to first intensification was 456 (95% CI 429–483) days. No intensification had occurred in 77.8, 59.5, 41.5, 28.1 and 22.4% of patients at 6\xa0months, 1, 2, 3\xa0years and the end of follow-up, respectively. Conclusions The patients with T2DM analysed in this study had a mean HbA1c of 9.2% at baseline, and this remained at ≥\u20098% for > 1 year. The time to the first treatment intensification was longer than that recommended by guidelines. Treatment was not intensified in a large percentage of patients, with almost 60% of patients not receiving intensification at 1\xa0year of follow-up.