Intensification patterns and the probability of HbA1c goal attainment in Type 2 diabetes mellitus: real‐world evidence for the concept of 'intensification inertia'. Issue 7 (21st February 2019)

• Record Type: Journal Article
• Authors: Pantalone, K. M.; Misra‐Hebert, A. D.; Hobbs, T. M.; Ji, X.; Kong, S. X.; Milinovich, A.; Weng, W.; Bauman, J. M.; Ganguly, R.; Burguera, B.; Kattan, M. W.; Zimmerman, R. S.
• Is Part Of: Diabetic medicine. Volume 37:Issue 7(2020)
• Page Start: 1114
• Page End: 1124
• Publication Date: 2019-02-21
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13900
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aims: To assess the effects of 'clinical' and 'intensification inertia' by evaluating the impact of different intensification interventions on the probability of HbA1c goal attainment using real‐world data. Methods: Electronic health records (Cleveland Clinic, 2005–2016) were used to identify 7389 people with Type 2 diabetes mellitus and HbA1c ≥53 mmol/mol (≥7.0%), despite a stable regimen of two oral antihyperglycaemic drugs for ≥6 months. The participants were stratified by index HbA1c and analysed over a 6‐month period for pharmacological intensification, and then for 12 additional months for HbA1c goal attainment (<53 mmol/mol). Results: The probability of HbA1c goal attainment (Kaplan–Meier analysis) in the group with index HbA1c 53–63 mmol/mol (7.0–7.9%) was highest with the addition of oral antidiabetic drugs [57.3% (95% CI 52.1, 62.0)] or glucagon‐like peptide‐1 receptor agonists [56.7% (95% CI 40.4, 68.6)], in the 64–74 mmol/mol (8.0–8.9%) group with the addition of oral antidiabetic drugs [31.9% (95% CI 25.1, 38.1)] or insulin [30.6% (95% CI 18.3, 41.0)], and in the ≥75 mmol/mol (≥9.0%) group with the addition of glucagon‐like peptide‐1 receptor agonists [53.0% (95% CI 31.8, 67.6)] or insulin [43.5% (95% CI 36.4, 49.8)]. Conclusions: Numerical, but not statistically significant, differences in HbA1c goal attainment probability by type of intensification were most marked in people with the highest index HbA1c [≥75 mmol/mol (≥9.0%)]; in this group, injectable therapy showed trends toward greater glycaemic control benefits. Additional research into the phenomenon of intensification inertia is warranted. What's new?: 'Clinical inertia', lack of timely treatment intensification when indicated, is a common barrier to achieving Type 2 diabetes mellitus glycaemic goals. Another type of inertia that warrants investigation is 'intensification inertia', the implementation of intensification measures that result in little‐to‐no impact on attainment of target HbA1c . This study found that the real‐world probability of HbA1c goal attainment in people with uncontrolled Type 2 diabetes may vary by type of pharmacological intervention and baseline HbA1c . Awareness of intensification inertia should help reduce the frequency with which clinicians choose forms of intensification that may have a very low probability of success (HbA1c goal attainment).