PMID- 21156883
OWN - NLM
STAT- MEDLINE
DCOM- 20110616
LR  - 20240322
IS  - 1715-5258 (Electronic)
IS  - 0008-350X (Print)
IS  - 0008-350X (Linking)
VI  - 56
IP  - 12
DP  - 2010 Dec
TI  - Clinical inertia in patients with T2DM requiring insulin in family practice.
PG  - e418-24
AB  - OBJECTIVE: To describe the clinical status of patients with type 2 diabetes 
      mellitus (T2DM) in the primary care setting at insulin initiation and during 
      follow-up, and to assess the efficacy of insulin initiation and intensification. 
      DESIGN: Ontario FPs from the IMS Health database who had prescribed insulin at 
      least once in the 12 months before November 2006 were randomly selected to 
      receive an invitation to participate. Eligible and consenting FPs completed a 
      questionnaire for each of up to 10 consecutive eligible patients. Patient data 
      were recorded from 3 time points. SETTING: Family practices in Ontario, Canada. 
      PARTICIPANTS: One hundred and nine FPs and 379 of their T2DM patients taking 
      insulin (with or without oral agents). MAIN OUTCOME MEASURES: Glycated hemoglobin 
      (HbA(1)(c)) levels, daily insulin dose, and use of concomitant oral agents at 
      insulin initiation and 2 subsequent visits. RESULTS: Data from each patient were 
      obtained on insulin initiation and intensification, glycemic control, further 
      pharmacologic therapy, and related complications. Mean time from diagnosis of 
      T2DM to insulin initiation was 9.2 years. Mean HbA(1)(c) values were 9.5% before 
      insulin initiation, 8.1% at visit 2 (median 1.2 years later), and 7.9% at visit 3 
      (median 3.9 years after initiation). Mean insulin dose was 24 units at 
      initiation, 48 units at visit 2, and 65 units at visit 3. At visit 3, 20% of 
      patients continued to have very poor glycemic control (HbA(1)(c) > 9.0%). With the 
      exception of a decrease in sulfonylurea use, concomitant use of oral 
      antihyperglycemic agents remained static over time. CONCLUSION: Even in patients 
      identified as being sufficiently high risk to warrant insulin therapy, a clinical 
      care gap exists in physician efforts to achieve and sustain recommended HbA(1)(c) 
      target levels. Family physicians need strategies to facilitate earlier initiation 
      and ongoing intensification of insulin therapy.
FAU - Harris, Stewart B
AU  - Harris SB
AD  - Department of Family Medicine and Family Medicine Studies, Schulich School of 
      Medicine and Dentistry, University of Western Ontario, London. sharris1@uwo.ca
FAU - Kapor, Jovana
AU  - Kapor J
FAU - Lank, Cynthia N
AU  - Lank CN
FAU - Willan, Andrew R
AU  - Willan AR
FAU - Houston, Tricia
AU  - Houston T
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Canada
TA  - Can Fam Physician
JT  - Canadian family physician Medecin de famille canadien
JID - 0120300
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
SB  - IM
MH  - Adult
MH  - Diabetes Mellitus, Type 2/*drug therapy
MH  - Family Practice
MH  - Glycated Hemoglobin/metabolism
MH  - Humans
MH  - Hyperglycemia/*drug therapy
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Insulin/administration & dosage/*therapeutic use
MH  - Logistic Models
MH  - Middle Aged
MH  - Ontario
MH  - *Physicians, Primary Care
MH  - *Practice Patterns, Physicians'
MH  - Primary Health Care
MH  - Surveys and Questionnaires
PMC - PMC3001949
EDAT- 2010/12/16 06:00
MHDA- 2011/06/17 06:00
PMCR- 2010/12/01
CRDT- 2010/12/16 06:00
PHST- 2010/12/16 06:00 [entrez]
PHST- 2010/12/16 06:00 [pubmed]
PHST- 2011/06/17 06:00 [medline]
PHST- 2010/12/01 00:00 [pmc-release]
AID - 56/12/e418 [pii]
AID - 056e418 [pii]
PST - ppublish
SO  - Can Fam Physician. 2010 Dec;56(12):e418-24.