| Autor: |
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. |
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| Zdroj: |
Diabetic Medicine; Jul2020, Vol. 37 Issue 7, p1114-1124, 11p, 1 Diagram, 2 Charts, 1 Graph |
| Abstrakt: |
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). [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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