Inertia study: Clinical inertia in non-insulinized patients on oral hypoglycemic treatment. A study in Spanish primary and specialty care settings

José Miguel González-Clemente, Beatriu Font, Raquel Lahoz, Gemma Llauradó, Gemma Gambús

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    17 Citations (Scopus)

    Abstract

    Background and objective To study clinical inertia in the management of oral hypoglycemic agents (OHA) in non-insulin treated patients with type 2 diabetes mellitus (T2DM) in Spain. Patients and method Epidemiological, cross-sectional, retrospective (2 years), multicenter study. Clinical inertia was measured as the total number of patients without OHA treatment intensification divided by the total number of patients with inadequate HbA 1c values (≥ 7%), multiplied by 100. Total clinical inertia (TCI) was the absence of OHA treatment intensification in all visits with a HbA 1c ≥ 7% values in the previous 2 years; partial clinical inertia (PCI) occurred when this absence only occurred in some of these visits. We assessed OHA treatment compliance with the Morisky-Green test. Results We included 2,971 patients, 1,416 adequately controlled (HbA1c < 7%) and 1,555 inadequately controlled (HbA1c ≥ 7%). PCI prevalence was 52.5%(95% confidence interval [95% CI] 52.4-52.6%) while TCI prevalence was 12.8% (95% CI 12.2-13.8%). PCI was lower in patients adequately controlled as compared with those inadequately controlled (31.4% vs. 71.8%; P <.001). PCI was associated with sedentary lifestyle, hypertension and higher prevalence of micro and macrovascular complications. Only 38.0% of patients were compliant with the OHA treatment, being this percentage even lower in subjects with ICP. Two variables were independently associated with ICP: female sex (odds ratio [OR] 1.43; 95% CI 1.09-1.86%) and a shorter duration of DM2 (OR 0.98; 95% CI 0.95-0.99). Conclusions One out of 2 patients with T2DM and treated with OHA without insulin suffer from PCI. Only 4 out of 10 patients are compliant with OHA treatment. Female sex and a shorter duration of T2DM are independently associated with PCI. © 2013 Elsevier España, S.L.
    Original languageEnglish
    Pages (from-to)478-484
    JournalMedicina Clinica
    Volume142
    Issue number11
    DOIs
    Publication statusPublished - 6 Jun 2014

    Keywords

    • Clinical inertia
    • Glycosylated haemoglobin
    • Morisky-Green test
    • Type 2 diabetes

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