Therapeutic inertia in type 2 diabetes: insights from the PANORAMA study in France

Abstract

“Therapeutic inertia” is usually defined as the failure to change or uptitrate treatment strategy when a disease is uncontrolled. In patients with type 2 diabetes (T2D) this may occur with antidiabetes treatments and/or treatment for various cardiovascular risk factors. The PANORAMA study (NCT00916513) compared individual HbA1c targets and actual HbA1c levels in 5817 patients with T2D in nine European countries, and investigated the reasons why therapeutic choices made by physicians sometimes differ from expert guidelines for this disease. Thus it provides an insight into therapeutic inertia, a fashionable paradigm which can be challenged. This article reports data specifically from the French cohort of patients (n=759). We will try to demonstrate that criticising physicians for not strictly applying the expert T2D guidelines would not be beneficial as the clinical background for this apparent therapeutic inertia is complex. It appears that it may be more clinically relevant and useful to understand the reasons why the therapeutic choice made by the physician-patient partnership can sometimes differ from guidelines. This pragmatic approach would not detract from the need to develop and implement expert guidelines as it is essential to have benchmarks to assess temporal trends of quality of healthcare delivered to patients with T2D at the national level. However, these treatment targets must be put into perspective for clinical practice. Following the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, it appears mandatory to individualize glycaemic targets to enable physicians to identify the most appropriate antidiabetes treatment for each patient.