Clinical inertia in people with type 2 diabetes: A retrospective cohort study of more than 80,000 people

Abstract

OBJECTIVE-To determine time to treatment intensification in people with type 2 diabetes treated with one, two, or three oral antidiabetes drugs (OADs) and associated levels of glycemic control. RESEARCH DESIGNANDMETHODSdThis was a retrospective cohort study based on 81,573 people with type 2 diabetes in the U.K. Clinical Practice Research Datalink between January 2004 and December 2006, with follow-up until April 2011. RESULTS-In people with HbA1c ≥7.0, ≥7.5, or ≥8.0% (≥53, ≥58, or ≥64 mmol/mol), median time from above HbA1c cutoff to intensification with an additional OAD was 2.9, 1.9, or 1.6 years, respectively, for those taking one OAD and >7.2, >7.2, and >6.9 years for those taking two OADs. Median time to intensification with insulin was>7.1,>6.1, or 6.0 years for those taking one, two, or threeOADs.Mean HbA1c at intensificationwith anOADor insulin for people taking one, two, or threeOADs was 8.7, 9.1, and 9.7%. In patients taking one, two, or threeOADs,median time fromtreatment initiation to intensificationwith anOADor insulin exceeded themaximumfollow-up time of 7.2 years. The probability of patients with poor glycemic control taking one, two, or three OADs, intensifying at end of follow-up with an OAD, was 21.1-43.6% and with insulin 5.1-12.0%. CONCLUSIONS-There are delays in treatment intensification in peoplewith type 2 diabetes despite suboptimal glycemic control. A substantial proportion of people remain in poor glycemic control for several years before intensification with OADs and insulin. © 2013 by the American Diabetes Association.