Osataphan Soravis, Chalermchai Thep, Ngaosuwan Kanchana
Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Bangkok, Thailand.
School of Anti-aging and Regenerative Medicine, Mae Fah Luang University, Bangkok, Thailand.
J Diabetes. 2017 Mar;9(3):267-274. doi: 10.1111/1753-0407.12410. Epub 2016 Jul 12.
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.
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.
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.
Clinical inertia can cause persistently poor glycemic control and speed up the progression of DR in T2D.
临床惰性是指未能依据循证指南强化治疗，对2型糖尿病（T2D）可产生短期和长期不良影响。本研究旨在证明临床惰性对血糖控制及糖尿病相关并发症的影响。
在泰国一家大学附属医院开展一项回顾性队列研究。对2010年1月至2014年12月的病历进行回顾性评估。患者分为两组：临床惰性组和非惰性组。临床惰性定义为，已服用两种口服降糖药且糖化血红蛋白（HbA1c）≥9%的患者，3个月内未起始胰岛素治疗。
从1206份病历中，识别出98例平均HbA1c为10.3%的患者并纳入研究。这些患者的中位随访时间为29.5个月，68.4%被归入临床惰性组。临床惰性组和非惰性组在6个月时平均（±标准差）HbA1c降幅分别为0.82±1.50%和3.02±1.80%（P<0.001），在研究结束时分别为1.46±1.85%和3.04±1.76%（P<0.001）。临床惰性与糖尿病视网膜病变（DR）进展的中位时间显著缩短相关；对数秩检验，P=0.02，且DR进展发生率更高（每1000人月10例对比2.2例；P=0.003）。临床惰性组DR进展的校正发病率比为4.92（95%置信区间1.11 - 21.77；P=0.036）。由全科医生治疗是与临床惰性相关的最强危险因素。
临床惰性可导致T2D患者血糖控制持续不佳，并加速DR进展。
