Clinical inertia and associated factors in the treatment of type 2 diabetes patients: an analysis from a multicenter study

Abstract

Objective To assess the clinical inertia and associated factors in type 2 diabetic (T2DM) patients with diet/exercise intervention or oral antidiabetic drugs (OADs) therapy. Methods Patients with baseline glycated hemoglobin A1c (HbA1c)≥7.0% who participated the study of Direct Medical Cost Investigation of Diabetes in Chinese Urban Tertiary Hospitals from March 2015 to May 2015 were recruited and their medication data of baseline and 6-month after follow-up were compared. Clinical inertia was defined as the failure to upgrade treatment after 6 months of follow-up [uninitiated with additional another OAD, glucagon-like peptide 1 (GLP-1) receptor agonist or insulin]. Multivariate Logistic regression was used to analyze the independent predictive factors of clinical inertia. Results A total of 178 patients [101 males and 77 females, (58±11) years, (7±7) years duration of diabetes] with the mean HbA1c (8.6±1.6)% were recruited in this study. 52.2%(93/178) T2DM patients experienced clinical inertia in the 6 months following-up period. Upgraded treatment include: additional initiated with another OADs [30.9%(55/178)]or insulin [16.3%(29/178)] or GLP-1 receptor agonists [0.6% (1/178)]. The main factors associated with clinical inertia were HbA1c 7.5%-8.9% (OR=3.437, 95%CI:1.421-8.309) and HbA1c≥9.0% (OR=9.738, 95%CI:3.634-26.901), diabetic retinopathy (OR=2.732, 95%CI:1.004-7.431), taking ≥2 OADs (OR=2.651, 95%CI:1.248-5.635) and diabetic duration (OR=1.064, 95%CI:1.005-1.126). Conclusions Clinical inertia affects more than half of T2DM patients with substandard glycemic control. Patients with longer duration of diabetes, poor glycemic control, taking ≥2 OADs and complicated diabetic retinopathy are more likely to have clinical inertia. Key words: Diabetes mellitus, type 2; Clinical inertia; Oral antidiabetic drug therapy; Lifestyle modification