Time to Treatment Intensification to Reduce Diabetes-Related Complications: A Post Hoc Study

Overview

Journal Healthcare (Basel)

Specialty Health Services

Date 2022 Sep 23

PMID 36141285

Authors

Piranee Kaewbut

Natapong Kosachunhanun

Arintaya Phrommintikul

Dujrudee Chinwong

John J Hall

Surarong Chinwong

Affiliations

Soon will be listed here.

Abstract

Patients with type 2 diabetes mellitus (T2DM) can be affected by clinical inertia, leading to abysmal results. Studies on a suitable timeframe for treatment intensification remain scarce-especially outside of developed countries. This study aimed to explore the association between time to treatment intensification and diabetes-related complications. A database from a tertiary care hospital in Thailand was retrieved in order to conduct a retrospective cohort study for the years 2011-2017. This study comprised outpatients with T2DM presenting an HbA1c of ≥7.0%. Eligible patients were divided into three groups based on the time of treatment intensification: no delayed treatment intensification, treatment intensification within 6 months, and treatment intensification after 6 months. A Cox proportional hazards model was used to investigate the association between time to treatment intensification and diabetes-related complications. A total of 686 patients were included in the final analysis. During 6.5 years of median follow-up, the group with treatment intensification within 6 months was more strongly associated with diabetic nephropathy compared to the group with no delayed treatment intensification (adjusted HR 2.35; 95%CI 1.35-4.09). Our findings reveal that delaying treatment intensification by even 6 months can increase the likelihood of diabetic nephropathy compared to no delayed treatment intensification. We suggest that patients with T2DM whose blood glucose levels are outside the target range promptly receive treatment intensification.

Citing Articles

Removing barriers to management of adults with type 2 diabetes on insulin using continuous glucose monitoring in UK primary care practice: An expert consensus.

Seidu S, Avery L, Bell H, Brown P, Diggle J, Down S Diabet Med. 2024; 42(3):e15500.

PMID: 39676327 PMC: 11823331. DOI: 10.1111/dme.15500.

A retrospective cohort study of a community-based primary care program's effects on pharmacotherapy quality in low-income Peruvians with type 2 diabetes and hypertension.

Deaver J, Uchuya G, Cohen W, Foote J PLOS Glob Public Health. 2024; 4(8):e0003512.

PMID: 39173046 PMC: 11341050. DOI: 10.1371/journal.pgph.0003512.

Continuous glucose monitoring for the routine care of type 2 diabetes mellitus.

Ajjan R, Battelino T, Cos X, Del Prato S, Philips J, Meyer L Nat Rev Endocrinol. 2024; 20(7):426-440.

PMID: 38589493 DOI: 10.1038/s41574-024-00973-1.

Expanding the Role of Continuous Glucose Monitoring in Modern Diabetes Care Beyond Type 1 Disease.

Klupa T, Czupryniak L, Dzida G, Fichna P, Jarosz-Chobot P, Gumprecht J Diabetes Ther. 2023; 14(8):1241-1266.

PMID: 37322319 PMC: 10299981. DOI: 10.1007/s13300-023-01431-3.

References

Ziemer D, Miller C, Rhee M, Doyle J, Watkins Jr C, Cook C . Clinical inertia contributes to poor diabetes control in a primary care setting. Diabetes Educ. 2005; 31(4):564-71. DOI: 10.1177/0145721705279050. View

. Abridged for Primary Care Providers. Clin Diabetes. 2022; 40(1):10-38. PMC: 8865785. DOI: 10.2337/cd22-as01. View

Neugebauer R, Fireman B, Roy J, OConnor P . Impact of specific glucose-control strategies on microvascular and macrovascular outcomes in 58,000 adults with type 2 diabetes. Diabetes Care. 2013; 36(11):3510-6. PMC: 3816858. DOI: 10.2337/dc12-2675. View

. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131):837-53. View

. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131):854-65. View

Lin J, Zhou S, Wei W, Pan C, Lingohr-Smith M, Levin P . DOES CLINICAL INERTIA VARY BY PERSONALIZED A1C GOAL? A STUDY OF PREDICTORS AND PREVALENCE OF CLINICAL INERTIA IN A U.S. MANAGED-CARE SETTING. Endocr Pract. 2015; 22(2):151-61. DOI: 10.4158/EP15868.OR. View

Folse H, Mukherjee J, Sheehan J, Ward A, Pelkey R, Dinh T . Delays in treatment intensification with oral antidiabetic drugs and risk of microvascular and macrovascular events in patients with poor glycaemic control: An individual patient simulation study. Diabetes Obes Metab. 2017; 19(7):1006-1013. DOI: 10.1111/dom.12913. View

Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven P . Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2008; 360(2):129-39. DOI: 10.1056/NEJMoa0808431. View

Pantalone K, Misra-Hebert A, Hobbs T, Ji X, Kong S, Milinovich A . Clinical Inertia in Type 2 Diabetes Management: Evidence From a Large, Real-World Data Set. Diabetes Care. 2018; 41(7):e113-e114. DOI: 10.2337/dc18-0116. View

10.

Turnbull F, Abraira C, Anderson R, Byington R, Chalmers J, Duckworth W . Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia. 2009; 52(11):2288-98. DOI: 10.1007/s00125-009-1470-0. View

11.

Khunti K, Davies M . Clinical inertia-Time to reappraise the terminology?. Prim Care Diabetes. 2017; 11(2):105-106. DOI: 10.1016/j.pcd.2017.01.007. View

12.

Osataphan S, Chalermchai T, Ngaosuwan K . Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: A retrospective cohort study. J Diabetes. 2016; 9(3):267-274. DOI: 10.1111/1753-0407.12410. View

13.

Khunti K, Wolden M, Thorsted B, Andersen M, Davies M . Clinical inertia in people with type 2 diabetes: a retrospective cohort study of more than 80,000 people. Diabetes Care. 2013; 36(11):3411-7. PMC: 3816889. DOI: 10.2337/dc13-0331. View

14.

Ross S . Breaking down patient and physician barriers to optimize glycemic control in type 2 diabetes. Am J Med. 2013; 126(9 Suppl 1):S38-48. DOI: 10.1016/j.amjmed.2013.06.012. View

15.

Kaewbut P, Kosachunhanun N, Phrommintikul A, Chinwong D, Hall J, Chinwong S . Effect of Clinical Inertia on Diabetes Complications among Individuals with Type 2 Diabetes: A Retrospective Cohort Study. Medicina (Kaunas). 2022; 58(1). PMC: 8780665. DOI: 10.3390/medicina58010063. View

16.

Lebeau J, Cadwallader J, Aubin-Auger I, Mercier A, Pasquet T, Rusch E . The concept and definition of therapeutic inertia in hypertension in primary care: a qualitative systematic review. BMC Fam Pract. 2014; 15:130. PMC: 4094689. DOI: 10.1186/1471-2296-15-130. View

17.

Aujoulat I, Jacquemin P, Rietzschel E, Scheen A, Trefois P, Wens J . Factors associated with clinical inertia: an integrative review. Adv Med Educ Pract. 2014; 5:141-7. PMC: 4028485. DOI: 10.2147/AMEP.S59022. View

18.

Iradukunda A, Kembabazi S, Ssewante N, Kazibwe A, Kabakambira J . Diabetic Complications and Associated Factors: A 5-Year Facility-Based Retrospective Study at a Tertiary Hospital in Rwanda. Diabetes Metab Syndr Obes. 2022; 14:4801-4810. PMC: 8703046. DOI: 10.2147/DMSO.S343974. View

19.

Cucinotta D, Nicolucci A, Giandalia A, Lucisano G, Manicardi V, Mannino D . Temporal trends in intensification of glucose-lowering therapy for type 2 diabetes in Italy: Data from the AMD Annals initiative and their impact on clinical inertia. Diabetes Res Clin Pract. 2021; 181:109096. DOI: 10.1016/j.diabres.2021.109096. View

20.

Meredith A, Buatois E, Krenz J, Walroth T, Shenk M, Triboletti J . Assessment of clinical inertia in people with diabetes within primary care. J Eval Clin Pract. 2020; 27(2):365-370. DOI: 10.1111/jep.13429. View