University of Leicester, Leicester, UK.
Rio de Janeiro State University, Rio de Janeiro, Brazil.
Diabetes Obes Metab. 2018 Feb;20(2):427-437. doi: 10.1111/dom.13088. Epub 2017 Oct 1.
Therapeutic inertia, defined as the failure to initiate or intensify therapy in a timely manner according to evidence-based clinical guidelines, is a key reason for uncontrolled hyperglycaemia in patients with type 2 diabetes. The aims of this systematic review were to identify how therapeutic inertia in the management of hyperglycaemia was measured and to assess its extent over the past decade.
Systematic searches for articles published from January 1, 2004 to August 1, 2016 were conducted in MEDLINE and Embase. Two researchers independently screened all of the titles and abstracts, and the full texts of publications deemed relevant. Data were extracted by a single researcher using a standardized data extraction form.
The final selection for the review included 53 articles. Measurements used to assess therapeutic inertia varied across studies, making comparisons difficult. Data from low- to middle-income countries were scarce. In most studies, the median time to treatment intensification after a glycated haemoglobin (HbA1c) measurement above target was more than 1 year (range 0.3 to >7.2 years). Therapeutic inertia increased as the number of antidiabetic drugs rose and decreased with increasing HbA1c levels. Data were mainly available from Western countries. Diversity of inertia measures precluded meta-analysis.
Therapeutic inertia in the management of hyperglycaemia in patients with type 2 diabetes is a major concern. This is well documented in Western countries, but corresponding data are urgently needed in low- and middle-income countries, in view of their high prevalence of type 2 diabetes.
治疗惰性是指未能根据循证临床指南及时启动或加强治疗，这是 2 型糖尿病患者血糖控制不佳的一个主要原因。本系统评价的目的是确定过去十年间，在血糖管理中测量治疗惰性的方法，并评估其严重程度。
2004 年 1 月 1 日至 2016 年 8 月 1 日，我们对 MEDLINE 和 Embase 中的文章进行了系统检索。两名研究人员独立筛选了所有标题和摘要，并对认为相关的出版物进行全文筛选。一名研究人员使用标准化的数据提取表提取数据。
本综述的最终入选文章包括 53 篇。评估治疗惰性的测量方法在不同研究中存在差异，使得比较变得困难。来自中低收入国家的数据很少。在大多数研究中，糖化血红蛋白（HbA1c）测量值超过目标后，进行治疗强化的中位数时间超过 1 年（范围 0.3 至>7.2 年）。随着抗糖尿病药物数量的增加，治疗惰性增加，而随着 HbA1c 水平的升高，治疗惰性降低。数据主要来自西方国家。由于惰性测量方法的多样性，无法进行荟萃分析。
2 型糖尿病患者血糖管理中的治疗惰性是一个主要问题。这在西方国家已有充分的记录，但鉴于中低收入国家 2 型糖尿病的高患病率，迫切需要这些国家的数据。
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