Clinical inertia in type 2 diabetes management in a middle-income country: A retrospective cohort study

Autor: Khalijah Mohd Yusof, Noran Naqiah Hairi, Zainudin Mohd Ali, Foong Ming Moy, Feisul Idzwan Mustapha, Kim Sui Wan
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Pediatrics
Inertia
Physiology
Administration
Oral
Type 2 diabetes
Overweight
Antiplatelet Therapy
Biochemistry
Geographical Locations
Endocrinology
Medical Conditions
0302 clinical medicine
Diabetes diagnosis and management
030212 general & internal medicine
Multidisciplinary
Pharmaceutics
Physics
Classical Mechanics
Middle Aged
Oral Antiplatelet Therapy
Physiological Parameters
Physical Sciences
Medicine
Drug Therapy
Combination
Female
medicine.symptom
Research Article
Cohort study
Adult
medicine.medical_specialty
HbA1c
Asia
Endocrine Disorders
Science
030209 endocrinology & metabolism
Time-to-Treatment
Motion
03 medical and health sciences
Drug Therapy
Diabetes Mellitus
medicine
Humans
Hypoglycemic Agents
Hemoglobin
Obesity
Developing Countries
Survival analysis
Aged
Retrospective Studies
Medicine and health sciences
Glycated Hemoglobin
Biology and life sciences
Proportional hazards model
business.industry
Public health
Body Weight
Malaysia
Proteins
Retrospective cohort study
medicine.disease
Diagnostic medicine
Diabetes Mellitus
Type 2
Metabolic Disorders
People and Places
business
Zdroj: PLoS ONE, Vol 15, Iss 10, p e0240531 (2020)
PLoS ONE
ISSN: 1932-6203
Popis: BackgroundClinical inertia can lead to poor glycemic control among type 2 diabetes patients. However, there is paucity of information on clinical inertia in low- and middle-income countries including Malaysia. This study aimed to determine the time to treatment intensification among T2D patients with HbA1c of ≥7% (≥53 mmol/mol) in Malaysian public health clinics. The proportion of patients with treatment intensification and its associated factors were also determined.Material and methodsThis was a five-year retrospective open cohort study using secondary data from the National Diabetes Registry. The study setting was all public health clinics (n = 47) in the state of Negeri Sembilan, Malaysia. Time to treatment intensification was defined as the number of years from the index year until the addition of another oral antidiabetic drug or initiation of insulin. Life table survival analysis based on best-worst case scenarios was used to determine the time to treatment intensification. Discrete-time proportional hazards model was fitted for the factors associated with treatment intensification.ResultsThe mean follow-up duration was 2.6 (SD 1.1) years. Of 7,646 patients, the median time to treatment intensification was 1.29 years (15.5 months), 1.58 years (19.0 months) and 2.32 years (27.8 months) under the best-, average- and worst-case scenarios respectively. The proportion of patients with treatment intensification was 45.4% (95% CI: 44.2-46.5), of which 34.6% occurred only after one year. Younger adults, overweight, obesity, use of antiplatelet medications and poorer HbA1c were positively associated with treatment intensification. Patients treated with more oral antidiabetics were less likely to have treatment intensification.ConclusionClinical inertia is present in the management of T2D patients in Malaysian public health clinics. We recommend further studies in lower- and middle-income countries to explore its causes so that targeted strategies can be developed to address this issue.
Databáze: OpenAIRE
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