Primary Care Center (PCC) La Mina, Sant Adrià de Besòs , Barcelona , Spain.
Curr Med Res Opin. 2013 Nov;29(11):1495-502. doi: 10.1185/03007995.2013.833089. Epub 2013 Sep 6.
To assess clinical inertia, defined as failure to intensify antidiabetic treatment of patients who have not achieved the HbA1c therapeutic goal (≤7%).
Multicenter cross-sectional study. Clinical inertia was assessed in a random sample of type 2 diabetes mellitus (T2DM) patients seen in primary care centers.
A total of 2783 patients (51.3% males; mean age: 68 [±11.5] years; diabetes duration: 7.1 [±5.6] years; mean HbA1c: 6.8 [±1.5]) were analyzed. Of those, 997 (35.8%) had HbA1c >7%. Treatment was intensified in 66.8% and consisted of: dose increase (40.5%); addition of oral antidiabetic (45.8%); or insulin treatment initiation (3.7%). Mean HbA1c values in patients for whom treatment was intensified vs. non-intensified were 8.4% (±1.2) vs. 8.2% (±1.2), p < 0.05. Clinical inertia was detected in 33.2% of patients and diminished along with treatment complexity: lifestyle changes only (38.8%), oral monotherapy (40.3%), combined oral antidiabetics (34.5%), insulin monotherapy (26.1%) and combination of insulin and oral antidiabetics (21.4%). Clinical inertia decreased as HbA1c increased: 37.3% for HbA1c values ranging between 7.1%-8%; 29.4% for the 8.1%-9% HbA1c range and 27.1% for HbA1c ≥9%. Multivariate analysis confirmed that diabetes duration, step of treatment and HbA1c were related to inertia. For each unit of HbA1c increase clinical inertia decreased 47% (OR: 0.53).
The retrospective design of the study precluded an accurate investigation about reasons for lack of intensification that could actually be justified by some patient conditions, especially patients' lack of adherence.
Clinical inertia affected one third of T2DM patients with poor glycemic control and was greater in patients treated with only lifestyle changes or oral monotherapy. Treatment changes were performed when mean HbA1c values were 1.4 points above therapeutic goals.
评估临床惰性，即未能加强未达到 HbA1c 治疗目标（≤7%）的糖尿病患者的降糖治疗。
多中心横断面研究。在初级保健中心就诊的 2 型糖尿病（T2DM）患者的随机样本中评估了临床惰性。
共分析了 2783 例患者（51.3%为男性；平均年龄：68 [±11.5] 岁；糖尿病病程：7.1 [±5.6] 年；平均 HbA1c：6.8 [±1.5]）。其中，997 例（35.8%）HbA1c >7%。66.8%的患者接受了强化治疗，包括：增加剂量（40.5%）；加用口服降糖药（45.8%）；或起始胰岛素治疗（3.7%）。与未强化治疗的患者相比，接受强化治疗的患者的平均 HbA1c 值分别为 8.4%（±1.2）和 8.2%（±1.2），p<0.05。33.2%的患者存在临床惰性，且随着治疗复杂性的增加而减少：仅生活方式改变（38.8%）、口服单药治疗（40.3%）、联合口服降糖药（34.5%）、胰岛素单药治疗（26.1%）和胰岛素与口服降糖药联合治疗（21.4%）。随着 HbA1c 的升高，临床惰性降低：7.1%-8%HbA1c 范围内为 37.3%；8.1%-9%HbA1c 范围内为 29.4%；HbA1c≥9%范围内为 27.1%。多变量分析证实，糖尿病病程、治疗步骤和 HbA1c 与惰性相关。HbA1c 每增加 1 个单位，临床惰性降低 47%（OR：0.53）。
研究的回顾性设计排除了对缺乏强化治疗原因的准确调查，这些原因实际上可能因某些患者的情况而合理，尤其是患者缺乏依从性。
临床惰性影响了三分之一血糖控制不佳的 T2DM 患者，且在仅接受生活方式改变或口服单药治疗的患者中更为常见。当平均 HbA1c 值比治疗目标高 1.4 个点时，就会进行治疗改变。
