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DIABETOLOGY / CLINICAL RESEARCH
An observational study of clinical inertia among patients with type 2 diabetes mellitus in a tertiary care hospital
1
PhD’s Degree Program in Pharmacy, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
2
Division of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
3
Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
4
Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
5
School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
Submission date: 2020-05-29
Final revision date: 2020-07-13
Acceptance date: 2020-07-19
Online publication date: 2020-08-20
Publication date: 2026-02-28
Corresponding author
Surarong Chinwong
Department of Pharmaceutical Care Faculty of Pharmacy Chiang Mai University Thailand
Department of Pharmaceutical Care Faculty of Pharmacy Chiang Mai University Thailand
Arch Med Sci 2026;22(1):87-94
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Clinical inertia is a lack of treatment intensification despite a failure to achieve appropriate targets using a current management strategy. Research focusing on the clinical inertia in type 2 diabetes mellitus (T2DM) remains scant. This study aimed to investigate factors associated with clinical inertia among patients with T2DM.
Material and methods:
This observational study was conducted in a tertiary teaching hospital using medical records. T2DM patients attending the outpatient clinic between 1 January 2017 and 31 December 2017 were included. Failure to intensify the diabetes treatment of the participants was assessed. For this study, clinical inertia was defined as any T2DM patient event with an glycated haemoglobin (HbA1c) of ≥ 7.00% with no treatment intensification at the index date, or in a subsequent prescription written within the study time limits. Logistic regression analysis was used to determine associated factors.
Results:
Of 5756 T2DM outpatients, 994 patients were enrolled in this study, with 26.2% of patients presenting clinical inertia. This study found that factors associated with lower clinical inertia were the use of insulin, HbA1c level at the index date, lower number of antidiabetic drugs used, and treatment by specialists (all p-value < 0.05).
Conclusions:
Clinical inertia is a problem of T2DM treatment. Strategies should be developed to decrease this problem.
Clinical inertia is a lack of treatment intensification despite a failure to achieve appropriate targets using a current management strategy. Research focusing on the clinical inertia in type 2 diabetes mellitus (T2DM) remains scant. This study aimed to investigate factors associated with clinical inertia among patients with T2DM.
Material and methods:
This observational study was conducted in a tertiary teaching hospital using medical records. T2DM patients attending the outpatient clinic between 1 January 2017 and 31 December 2017 were included. Failure to intensify the diabetes treatment of the participants was assessed. For this study, clinical inertia was defined as any T2DM patient event with an glycated haemoglobin (HbA1c) of ≥ 7.00% with no treatment intensification at the index date, or in a subsequent prescription written within the study time limits. Logistic regression analysis was used to determine associated factors.
Results:
Of 5756 T2DM outpatients, 994 patients were enrolled in this study, with 26.2% of patients presenting clinical inertia. This study found that factors associated with lower clinical inertia were the use of insulin, HbA1c level at the index date, lower number of antidiabetic drugs used, and treatment by specialists (all p-value < 0.05).
Conclusions:
Clinical inertia is a problem of T2DM treatment. Strategies should be developed to decrease this problem.
REFERENCES (30)
1.
O’Connor PJ, Sperl-Hillen JAM, Johnson PE, Rush WA, Biltz G. Advances in patient safety clinical inertia and outpatient medical errors. In: Advances in Patient Safety: From Research to Implementation (Volume 2: Concepts and Methodology). Henriksen K, Battles JB, Marks ES, Lewin DI (eds). Rockville (MD): Agency for Healthcare Research and Quality (US) 2005.
2.
Mahabaleshwarkar R, Gohs F, Mulder H, et al. Patient and provider factors affecting clinical inertia in patients with type 2 diabetes on metformin monotherapy. Clin Ther 2017; 39: 1658-70.e6.
3.
Bailey CJ. Under-treatment of type 2 diabetes: causes and outcomes of clinical inertia. Int J Clin Pract 2016; 70: 988-95.
4.
Pantalone KM, Misra-Hebert AD, Hobbs TM, et al. Clinical inertia in type 2 diabetes management: evidence from a large, real-world data set. Diabetes Care 2018; 41: e113-e4.
5.
Reach G, Pechtner V, Gentilella R, Corcos A, Ceriello A. Clinical inertia and its impact on treatment intensification in people with type 2 diabetes mellitus. Diabetes Metab 2017; 43: 501-11.
6.
Ma CC, Duan CC, Huang RC, Tang HQ. Association of circulating cystatin C levels with type 2 diabetes mellitus: a systematic review and meta-analysis. Arch Med Sci 2019; 16: 648-56.
7.
Haberka M, Jankowski P, Kosior D, et al. Treatment goal attainment for secondary prevention in coronary patients with or without diabetes mellitus – Polish multicenter study POLASPIRE. Arch Med Sci 2023; 19: 305-12.
8.
Giugliano D, Maiorino MI, Bellastella G, Esposito K. Clinical inertia, reverse clinical inertia, and medication non-adherence in type 2 diabetes. J Endocrinol Invest 2019; 42: 495-503.
9.
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 2016; 22: 151-61.
10.
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 2017; 9: 267-74.
11.
Pholdee L, Vejakama P, Khunawaradisai N, Watcharathanakij S. Clinical inertia in type 2 diabetic patients in community hospitals in Ubon Ratchathani. Thai J Pharm Pract 2020; 12: 128-39.
12.
Paul SK, Klein K, Thorsted BL, Wolden ML, Khunti K. Delay in treatment intensification increases the risks of cardiovascular events in patients with type 2 diabetes. Cardiovasc Diabetol 2015; 14: 100.
13.
Khunti K, Gomes MB, Pocock S, et al. Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: a systematic review. Diabetes Obes Metab 2018; 20: 427-37.
14.
Alvarenga MA, Komatsu WR, de Sa JR, Chacra AR, Dib SA. Clinical inertia on insulin treatment intensification in type 2 diabetes mellitus patients of a tertiary public diabetes center with limited pharmacologic armamentarium from an upper-middle income country. Diabetol Metab Syndr 2018; 10: 77.
15.
Khunti S, Khunti K, Seidu S. Therapeutic inertia in type 2 diabetes: prevalence, causes, consequences and methods to overcome inertia. Ther Adv Endocrinol Metab 2019; 10: 2042018819844694.
16.
Medical records and statistics [Internet]. 2015 [cited 16 October 2019]. Available from: https://w2.med.cmu.ac.th/medre....
17.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-83.
18.
Machado-Duque ME, Ramirez-Riveros AC, Machado-Alba JE. Effectiveness and clinical inertia in patients with antidiabetic therapy. Int J Clin Pract 2017; 71: doi: 10.1111/ijcp.12954.
19.
Ruiz-Negron N, Wander C, McAdam-Marx C, Pesa J, Bailey RA, Bellows BK. Factors associated with diabetes-related clinical inertia in a managed care population and its effect on hemoglobin a1c goal attainment: a claims-based analysis. J Manag Care Spec Pharm 2019; 25: 304-13.
20.
Mata-Cases M, Franch-Nadal J, Real J, et al. Therapeutic inertia in patients treated with two or more antidiabetics in primary care: factors predicting intensification of treatment. Diabetes Obes Metab 2018; 20: 103-12.
21.
Fu AZ, Sheehan JJ. Treatment intensification for patients with type 2 diabetes and poor glycaemic control. Diabetes Obes Metab 2016; 18: 892-8.
22.
Khunti K, Nikolajsen A, Thorsted BL, Andersen M, Davies MJ, Paul SK. Clinical inertia with regard to intensifying therapy in people with type 2 diabetes treated with basal insulin. Diabetes Obes Metab 2016; 18: 401-9.
23.
Shah BR, Hux JE, Laupacis A, Zinman B, van Walraven C. Clinical inertia in response to inadequate glycemic control: do specialists differ from primary care physicians? Diabetes Care 2005; 28: 600-6.
24.
Harris SB, Kapor J, Lank CN, Willan AR, Houston T. Clinical inertia in patients with T2DM requiring insulin in family practice. Can Fam Physician 2010; 56: e418-24.
25.
Fu AZ, Qiu Y, Davies MJ, Radican L, Engel SS. Treatment intensification in patients with type 2 diabetes who failed metformin monotherapy. Diabetes Obes Metab 2011; 13: 765-9.
26.
Raebel MA, Ellis JL, Schroeder EB, et al. Intensification of antihyperglycemic therapy among patients with incident diabetes: a Surveillance Prevention and Management of Diabetes Mellitus (SUPREME-DM) study. Pharmacoepidemiol Drug Saf 2014; 23: 699-710.
27.
The VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360: 129-39.
28.
The ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358: 2560-72.
29.
The Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358: 2545-59.
30.
Shek AB, Alieva RB, Kurbanov RD, Hoshimov SU, Nizamov UI, Ziyaeva AV. Can metformin stabilize PCSK9 level in stable coronary artery disease patients treated with statins? Arch Med Sci Atheroscler Dis 2019; 4: e144-50.
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