Department of Psychiatry, The University of Texas at Austin Dell Medical School, Austin, TX, USA.
Center for Health Innovation, The New York Academy of Medicine, New York, NY, USA.
J Gen Intern Med. 2019 Mar;34(3):372-378. doi: 10.1007/s11606-018-4773-3. Epub 2018 Dec 18.
There are an increasing number of newer and better therapeutic options in the management of diabetes. However, a large proportion of diabetes patients still experience delays in intensification of treatment to achieve appropriate blood glucose targets-a phenomenon called clinical inertia. Despite the high prevalence of clinical inertia, previous research has not examined its long-term effects on diabetes-related health outcomes and mortality.
We sought to examine the impact of clinical inertia on the incidence of diabetes-related complications and death. We also examined how the impact of clinical inertia would vary by the length of treatment delay and population characteristics.
We developed an agent-based model of diabetes and its complications. The model was parameterized and validated by data from health surveys, cohort studies, and trials.
We studied a simulated cohort of patients with diabetes in San Antonio, TX.
We examined 25-year incidences of diabetes-related complications, including retinopathy, neuropathy, nephropathy, and cardiovascular disease.
One-year clinical inertia could increase the cumulative incidences of retinopathy, neuropathy, and nephropathy by 7%, 8%, and 18%, respectively. The effects of clinical inertia could be worse for populations who have a longer treatment delay, are aged 65 years or older, or are non-Hispanic whites.
Clinical inertia could result in a substantial increase in the incidence of diabetes-related complications and mortality. A validated agent-based model can be used to study the long-term effect of clinical inertia and, thus, inform clinicians and policymakers to design effective interventions.
在糖尿病的治疗管理中，有越来越多的新型且更有效的治疗选择。然而，仍有很大一部分糖尿病患者在加强治疗以达到适当的血糖目标方面存在延迟，这种现象被称为临床惰性。尽管临床惰性的普遍程度很高，但之前的研究并未探讨其对糖尿病相关健康结局和死亡率的长期影响。
我们旨在研究临床惰性对糖尿病相关并发症和死亡的发生的影响。我们还研究了临床惰性的影响随治疗延迟时间的长短和人群特征的变化而变化的情况。
我们开发了一个基于代理的糖尿病及其并发症模型。该模型通过健康调查、队列研究和试验的数据进行了参数化和验证。
我们研究了在德克萨斯州圣安东尼奥的一个模拟糖尿病患者队列。
我们检查了与糖尿病相关的并发症的 25 年发生率，包括视网膜病变、神经病变、肾病和心血管疾病。
一年的临床惰性可使视网膜病变、神经病变和肾病的累积发生率分别增加 7%、8%和 18%。对于治疗延迟时间较长、年龄在 65 岁或以上或为非西班牙裔白种人的人群，临床惰性的影响可能更糟。
临床惰性可能导致糖尿病相关并发症和死亡率的大幅增加。经过验证的基于代理的模型可用于研究临床惰性的长期影响，从而为临床医生和政策制定者提供信息，以设计有效的干预措施。
