PMID- 30386438
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240403
IS  - 1758-5996 (Print)
IS  - 1758-5996 (Electronic)
IS  - 1758-5996 (Linking)
VI  - 10
DP  - 2018
TI  - 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.
PG  - 77
LID - 10.1186/s13098-018-0382-x [doi]
LID - 77
AB  - BACKGROUND: Clinical inertia is related to the difficulty of achieving and 
      maintaining optimal glycemic control. It has been extensively studied the delay 
      of the period to insulin introduction in type 2 diabetes mellitus (T2DM) 
      patients. This study aims to evaluate clinical inertia of insulin treatment 
      intensification in a group of T2DM patients followed at a tertiary public 
      Diabetes Center with limited pharmacologic armamentarium (Metformin, 
      Sulphonylurea and Human Insulin). METHODS: This is a real life retrospective 
      record based study with T2DM patients. Demographic, clinical and laboratory 
      characteristics were reviewed. Clinical inertia was considered when the patients 
      did not achieve the individualized glycemic goals and there were no changes on 
      insulin daily dose in the period. RESULTS: We studied 323 T2DM patients on 
      insulin therapy (plus Metformin and or Sulphonylurea) for a period of 2 years. 
      The insulin daily dose did not change in the period and the glycated hemoglobin 
      (A1c) ranged from 8.8 + 1.8% to 8.7 +/- 1.7% (basal vs 1st year; ns) and to 
      8.5 +/- 1.8% (basal vs 2nd year; p = 0.035). The clinical inertia prevalence was 
      65.8% (basal), 61.9% (after 1 year) and 58.2% (after 2 years; basal vs 1st year 
      vs 2nd year; ns). In a subgroup of 100 patients, we also studied the first 
      2 years after insulin introduction. The insulin daily dose ranged from 
      0.22 +/- 0.12 to 0.32 +/- 0.24 IU/kg of body weight/day (basal vs 1st year; 
      p < 0.001) and to 0.39 +/- 0.26 IU/kg of body weight/day (basal vs 2nd year; 
      p < 0.05). The A1c ranged from 9.6 + 2.1% to 8.6 + 2% (basal vs 1st year; 
      p < 0.001) and to 8.7 + 1.7% (1st year vs 2nd year; ns). The clinical inertia 
      prevalence was 78.5% (at the moment of insulin therapy introduction), 56.2% 
      (after 1 year; p = 0.001) and 62.2% (after 2 years; ns). CONCLUSION: Clinical 
      inertia prevalence ranged from 56.2 to 78.5% at different moments of the insulin 
      therapy (first 2 years and long term) of T2DM patients followed at a tertiary 
      public Diabetes Center from an upper-middle income country with limited 
      pharmacologic armamentarium.
FAU - Alvarenga, Marcelo Alves
AU  - Alvarenga MA
AD  - Department of Medicine, Endocrinology Division, Diabetes Center, UNIFESP (Federal 
      University of Sao Paulo), Rua Estado de Israel, 639 Vila Clementino, Sao Paulo, 
      SP CEP 04022-001 Brazil. ISNI: 0000 0001 0514 7202. GRID: grid.411249.b
FAU - Komatsu, William Ricardo
AU  - Komatsu WR
AD  - Department of Medicine, Endocrinology Division, Diabetes Center, UNIFESP (Federal 
      University of Sao Paulo), Rua Estado de Israel, 639 Vila Clementino, Sao Paulo, 
      SP CEP 04022-001 Brazil. ISNI: 0000 0001 0514 7202. GRID: grid.411249.b
FAU - de Sa, Joao Roberto
AU  - de Sa JR
AD  - Department of Medicine, Endocrinology Division, Diabetes Center, UNIFESP (Federal 
      University of Sao Paulo), Rua Estado de Israel, 639 Vila Clementino, Sao Paulo, 
      SP CEP 04022-001 Brazil. ISNI: 0000 0001 0514 7202. GRID: grid.411249.b
FAU - Chacra, Antonio Roberto
AU  - Chacra AR
AD  - Department of Medicine, Endocrinology Division, Diabetes Center, UNIFESP (Federal 
      University of Sao Paulo), Rua Estado de Israel, 639 Vila Clementino, Sao Paulo, 
      SP CEP 04022-001 Brazil. ISNI: 0000 0001 0514 7202. GRID: grid.411249.b
FAU - Dib, Sergio Atala
AU  - Dib SA
AD  - Department of Medicine, Endocrinology Division, Diabetes Center, UNIFESP (Federal 
      University of Sao Paulo), Rua Estado de Israel, 639 Vila Clementino, Sao Paulo, 
      SP CEP 04022-001 Brazil. ISNI: 0000 0001 0514 7202. GRID: grid.411249.b
LA  - eng
PT  - Journal Article
DEP - 20181029
PL  - England
TA  - Diabetol Metab Syndr
JT  - Diabetology & metabolic syndrome
JID - 101488958
PMC - PMC6206856
EDAT- 2018/11/06 06:00
MHDA- 2018/11/06 06:01
PMCR- 2018/10/29
CRDT- 2018/11/03 06:00
PHST- 2018/07/23 00:00 [received]
PHST- 2018/10/25 00:00 [accepted]
PHST- 2018/11/03 06:00 [entrez]
PHST- 2018/11/06 06:00 [pubmed]
PHST- 2018/11/06 06:01 [medline]
PHST- 2018/10/29 00:00 [pmc-release]
AID - 382 [pii]
AID - 10.1186/s13098-018-0382-x [doi]
PST - epublish
SO  - Diabetol Metab Syndr. 2018 Oct 29;10:77. doi: 10.1186/s13098-018-0382-x. 
      eCollection 2018.