Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: A retrospective cohort study

J Diabetes. 2017 Mar;9(3):267-274. doi: 10.1111/1753-0407.12410. Epub 2016 Jul 12.

Abstract

Background: Clinical inertia is a failure to intensify treatment according to evidence-based guidelines, and can have both short- and long-term adverse effects for type 2 diabetes (T2D). The aim of the present study was to demonstrate the effects of clinical inertia on glycemic control and diabetes-related complications.

Methods: A retrospective cohort study was conducted at a university-based hospital in Thailand. Medical records were evaluated retrospectively from January 2010 to December 2014. Patients were classified into two groups: clinical inertia and non-inertia. Clinical inertia was defined as failure to initiate insulin within 3 months in patients with HbA1c ≥9 % who were already taking two oral antidiabetic agents.

Results: From 1206 records, 98 patients with mean HbA1c of 10.3 % were identified and enrolled in the study. The median follow-up time of these patients was 29.5 months and 68.4 % were classified into the clinical inertia group. The mean (± SD) HbA1c decrement in the clinical inertia and non-inertia groups was 0.82 ± 1.50 % and 3.02 ± 1.80 %, respectively, at 6 months (P < 0.001) and 1.46 ± 1.85 % and 3.04 ± 1.76 %, respectively, at the end of study (P < 0.001). Clinical inertia was associated with a significantly shorter median time to progression of diabetic retinopathy (DR); log rank test, P = 0.02 and a higher incidence of DR progression (10 vs 2.2 cases per 1000 person-months; P = 0.003). The adjusted incidence rate ratio for DR progression in the clinical inertia group was 4.92 (95 % confidence interval 1.11-21.77; P = 0.036). Being treated by general practitioners was the strongest risk factor associated with clinical inertia.

Conclusions: Clinical inertia can cause persistently poor glycemic control and speed up the progression of DR in T2D.

Keywords: Thailand; delayed insulin initiation; microvascular complication; poor glycemic control; 推迟启动胰岛素治疗,微血管并发症,血糖控制不佳,泰国.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetic Retinopathy / diagnosis*
  • Diabetic Retinopathy / etiology
  • Disease Progression
  • Female
  • Glycated Hemoglobin A / metabolism*
  • Hospitals, University
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Insulin / therapeutic use*
  • Logistic Models
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Thailand
  • Time Factors

Substances

  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin