PMID- 31884573
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 1869-6953 (Print)
IS  - 1869-6961 (Electronic)
IS  - 1869-6961 (Linking)
VI  - 11
IP  - 2
DP  - 2020 Feb
TI  - Clinical Inertia in Poorly Controlled Type 2 Diabetes Mellitus Patients with 
      Obesity: An Observational Retrospective Study.
PG  - 437-451
LID - 10.1007/s13300-019-00745-5 [doi]
AB  - INTRODUCTION: To evaluate clinical inertia in patients with type 2 diabetes 
      mellitus (T2DM), obesity and poor glycaemic control in routine clinical practice. 
      METHODS: This was a retrospective, observational study based on the analysis of 
      medical records from the BIG-PAC(R) database. Subjects who required medical care in 
      2013 with the following characteristics were enrolled in the study: age 
      >/= 30 years, diagnosis of T2DM, glycosylated haemoglobin (HbA1c) >/= 8%, obesity 
      (body mass index [BMI] >/= 30 kg/m(2)) and treatment with >/= 2 oral antidiabetic 
      drugs (OADs). Inertia was evaluated by time (days) to the first intensification 
      during the period while HbA1c levels were >/= 8% and percentage of patients whose 
      treatment was not intensified at 6 months, 1, 2 and 3 years and the end of 
      follow-up. The minimum length of follow-up was 4 years. Descriptive analyses and 
      Kaplan-Meier survival curves were performed. RESULTS: A total of 13,824 patients 
      with T2DM receiving >/= 2 OADs were identified; of these 2709 (19.6%) had 
      HbA1c >/= 8% and BMI >/= 30 kg/m(2), thus fulfilling the inclusion criteria. Of these 
      2709 patients, the mean age was 65.5 (standard deviation [SD] 12.0) years; 54.9% 
      were male, mean HbA1c level was 9.2% (SD 1.3%); mean BMI was 32.1 (SD 
      0.9) kg/m(2); and mean time from diagnosis was 8.2 (SD 3.0) years. HbA1c remained 
      >/= 8% for a median of 440 (95% confidence interval [CI] 421-459) days. The median 
      time to first intensification was 456 (95% CI 429-483) days. No intensification 
      had occurred in 77.8, 59.5, 41.5, 28.1 and 22.4% of patients at 6 months, 1, 2, 
      3 years and the end of follow-up, respectively. CONCLUSIONS: The patients with 
      T2DM analysed in this study had a mean HbA1c of 9.2% at baseline, and this 
      remained at >/= 8% for > 1 year. The time to the first treatment intensification 
      was longer than that recommended by guidelines. Treatment was not intensified in 
      a large percentage of patients, with almost 60% of patients not receiving 
      intensification at 1 year of follow-up.
FAU - Romera, Irene
AU  - Romera I
AD  - Medical Department, Eli Lilly and Company, Alcobendas, Madrid, Spain. 
      romera_irene@lilly.com.
FAU - Diaz, Silvia
AU  - Diaz S
AD  - Medical Department, Eli Lilly and Company, Alcobendas, Madrid, Spain.
FAU - Sicras-Mainar, Antoni
AU  - Sicras-Mainar A
AD  - Real Life Data, Badalona, Barcelona, Spain.
FAU - Lopez-Simarro, Flora
AU  - Lopez-Simarro F
AD  - CAP Martorell, Martorell, Barcelona, Spain.
FAU - Dilla, Tatiana
AU  - Dilla T
AD  - Medical Department, Eli Lilly and Company, Alcobendas, Madrid, Spain.
FAU - Artime, Esther
AU  - Artime E
AD  - Medical Department, Eli Lilly and Company, Alcobendas, Madrid, Spain.
FAU - Reviriego, Jesus
AU  - Reviriego J
AD  - Medical Department, Eli Lilly and Company, Alcobendas, Madrid, Spain.
LA  - eng
PT  - Journal Article
DEP - 20191228
PL  - United States
TA  - Diabetes Ther
JT  - Diabetes therapy : research, treatment and education of diabetes and related 
      disorders
JID - 101539025
PMC - PMC6995792
OTO - NOTNLM
OT  - Glycaemic control
OT  - Intensification
OT  - Obese
OT  - Observational
OT  - Real-world evidence
OT  - Retrospective
OT  - T2DM
OT  - Therapeutic inertia
EDAT- 2019/12/31 06:00
MHDA- 2019/12/31 06:01
PMCR- 2019/12/28
CRDT- 2019/12/30 06:00
PHST- 2019/10/14 00:00 [received]
PHST- 2019/12/31 06:00 [pubmed]
PHST- 2019/12/31 06:01 [medline]
PHST- 2019/12/30 06:00 [entrez]
PHST- 2019/12/28 00:00 [pmc-release]
AID - 10.1007/s13300-019-00745-5 [pii]
AID - 745 [pii]
AID - 10.1007/s13300-019-00745-5 [doi]
PST - ppublish
SO  - Diabetes Ther. 2020 Feb;11(2):437-451. doi: 10.1007/s13300-019-00745-5. Epub 2019 
      Dec 28.