Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: A retrospective cohort study1: 临床惰性可导致2型糖尿病患者新发视网膜病变或视网膜病变进展:一项回顾性队列研究. (12th July 2016)

• Record Type: Journal Article
• Authors: Osataphan, Soravis; Chalermchai, Thep; Ngaosuwan, Kanchana
• Is Part Of: Journal of diabetes. Volume 9:Number 3(2017:Jul.)
• Page Start: 267
• Page End: 274
• Publication Date: 2016-07-12
• Subjects: delayed insulin initiation -- microvascular complication -- poor glycemic control -- Thailand; 推迟启动胰岛素治疗, 微血管并发症, 血糖控制不佳, 泰国; Diabetes -- Periodicals; 618.3646005
• DOI: 10.1111/1753-0407.12410
• Languages: English
• ISSNs: 1753-0393

Abstract

Abstract: Background: Clinical inertia is a failure to intensify treatment according to evidence‐based guidelines, and can have both short‐ and long‐term adverse effects for type 2 diabetes (T2D). The aim of the present study was to demonstrate the effects of clinical inertia on glycemic control and diabetes‐related complications. Methods: A retrospective cohort study was conducted at a university‐based hospital in Thailand. Medical records were evaluated retrospectively from January 2010 to December 2014. Patients were classified into two groups: clinical inertia and non‐inertia. Clinical inertia was defined as failure to initiate insulin within 3 months in patients with HbA1c ≥9 % who were already taking two oral antidiabetic agents. Results: From 1206 records, 98 patients with mean HbA1c of 10.3 % were identified and enrolled in the study. The median follow‐up time of these patients was 29.5 months and 68.4 % were classified into the clinical inertia group. The mean (± SD) HbA1c decrement in the clinical inertia and non‐inertia groups was 0.82 ± 1.50 % and 3.02 ± 1.80 %, respectively, at 6 months ( P < 0.001) and 1.46 ± 1.85 % and 3.04 ± 1.76 %, respectively, at the end of study ( P < 0.001). Clinical inertia was associated with a significantly shorter median time to progression of diabetic retinopathy (DR); log rank test, P = 0.02 and a higher incidence of DR progression (10 vs 2.2 cases per 1000 person‐months; P = 0.003). The adjusted incidence rate ratio for DR progression in the clinical inertia group was 4.92 (95 % confidence interval 1.11–21.77; P = 0.036). Being treated by general practitioners was the strongest risk factor associated with clinical inertia. Conclusions: Clinical inertia can cause persistently poor glycemic control and speed up the progression of DR in T2D. Highlights: Transforming the clinical trials into the real‐life practice, clinical inertia speeds up the progression of diabetic retinopathy in type 2 diabetes. General practitioners remain the major factor for clinical inertia in type 2 diabetes. Kaplan–Meier curves for the occurrence of new or progressive diabetic retinopathy between the clinical inertia and non‐inertia groups.