WEDNESDAY, July 5, 2017 (HealthDay News) -- Therapeutic inertia occurs in 19.1 percent of patients with type 2 diabetes with hemoglobin A1c (HbA1c) ≥8 percent on two or more non-insulin antidiabetic drugs (NIADs), according to a study published online June 28 in Diabetes, Obesity and Metabolism.
Manel Mata-Cases, M.D., Ph.D., from the Institut Universitari d'Investigació en Atenció Primària Jordi Gol in Barcelona, Spain, and colleagues examined the patterns and predictors of treatment intensification in patients with type 2 diabetes.
The researchers found that 26.2 percent of the 23,678 patients with HbA1c ≥7 percent were censored without treatment intensification after a median follow-up of 4.2 years. Therapeutic inertia, defined as no intensification if Hba1c was ≥8 percent at baseline or during follow-up, was seen in 18.1 percent of the 12,730 patients with HbA1c of ≥8 percent at baseline or during follow-up. The mean HbA1c values at initiation of insulin and NIAD were 9.4 ± 1.5 and 8.7 ± 1.3 percent, respectively, in the overall cohort. The median time to first intensification was 17.1 and 10.1 months in patients with HbA1c 8.0 to 9.9 percent and >10 percent, respectively. HbA1c values 8.0 to 9.9 percent and >10 percent and diabetes duration ≥20 years were variables strongly associated with intensification (subhazard ratios, 1.7, 2.5, and 1.25, respectively).
"Both the HbA1c thresholds and the time until therapy intensification exceeded current recommendations," the authors write.