Abstract
BackgroundClinical inertia is related to the difficulty of achieving and maintaining optimal glycemic control. It has been extensively studied the delay of the period to insulin introduction in type 2 diabetes mellitus (T2DM) patients. This study aims to evaluate clinical inertia of insulin treatment intensification in a group of T2DM patients followed at a tertiary public Diabetes Center with limited pharmacologic armamentarium (Metformin, Sulphonylurea and Human Insulin).MethodsThis is a real life retrospective record based study with T2DM patients. Demographic, clinical and laboratory characteristics were reviewed. Clinical inertia was considered when the patients did not achieve the individualized glycemic goals and there were no changes on insulin daily dose in the period.ResultsWe studied 323 T2DM patients on insulin therapy (plus Metformin and or Sulphonylurea) for a period of 2 years. The insulin daily dose did not change in the period and the glycated hemoglobin (A1c) ranged from 8.8 + 1.8% to 8.7 ± 1.7% (basal vs 1st year; ns) and to 8.5 ± 1.8% (basal vs 2nd year; p = 0.035). The clinical inertia prevalence was 65.8% (basal), 61.9% (after 1 year) and 58.2% (after 2 years; basal vs 1st year vs 2nd year; ns). In a subgroup of 100 patients, we also studied the first 2 years after insulin introduction. The insulin daily dose ranged from 0.22 ± 0.12 to 0.32 ± 0.24 IU/kg of body weight/day (basal vs 1st year; p < 0.001) and to 0.39 ± 0.26 IU/kg of body weight/day (basal vs 2nd year; p < 0.05). The A1c ranged from 9.6 + 2.1% to 8.6 + 2% (basal vs 1st year; p < 0.001) and to 8.7 + 1.7% (1st year vs 2nd year; ns). The clinical inertia prevalence was 78.5% (at the moment of insulin therapy introduction), 56.2% (after 1 year; p = 0.001) and 62.2% (after 2 years; ns).ConclusionClinical inertia prevalence ranged from 56.2 to 78.5% at different moments of the insulin therapy (first 2 years and long term) of T2DM patients followed at a tertiary public Diabetes Center from an upper-middle income country with limited pharmacologic armamentarium.
Highlights
Clinical inertia is related to the difficulty of achieving and maintaining optimal glycemic control
The most frequent oral anti-hyperglycemic therapy associated to insulin was Metformin (MET) (38.4%), followed by the association of MET + sulphonylurea (SU) (16.1%) and 24.1% of the patients did not use antihyperglycemic therapy, but only insulin
The total insulin daily dose ranged from 0.64 ± 0.4 to 0.67 ± 0.43 International Units (IU)/kg of body weight/day in the first year and to 0.67 ± 0.41 IU/kg of body weight/day in the second year (Table 1)
Summary
Clinical inertia is related to the difficulty of achieving and maintaining optimal glycemic control. While the difficulty of maintaining the desired A1c level over time is related to both lifestyle and type of prescribed medication, it derives primarily from the progressive decline in beta cell function, with the need of insulin as the natural result of this temporal process [8, 9, 11, 34] Another important aspect related to the difficulty of achieving and maintaining optimal glycemic control is the clinical inertia, defined as the failure to initiate or intensify therapy when indicated [14,15,16, 31,32,33,34]. It is well documented in Western countries, similar data in low-middle income countries are lacking [51,52,53], in the real world public healthcare system context where there are restrictions on antihyperglycemic therapy availability
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
