Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: A retrospective cohort study.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Clinical inertia can cause persistently poor glycemic control and speed up the progression of DR in T2D.
Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Bangkok, Thailand.
Soravis
S
Osataphan
School of Anti-aging and Regenerative Medicine, Mae Fah Luang University, Bangkok, Thailand.
Thep
T
Chalermchai
Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Bangkok, Thailand.
Kanchana
http://orcid.org/0000-0003-4392-269X
K
Ngaosuwan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000209:etiology; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006785:Hospitals, University; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013785:Thailand; D013997:Time Factors
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
Thailand; delayed insulin initiation; microvascular complication; poor glycemic control; 推迟启动胰岛素治疗,微血管并发症,血糖控制不佳,泰国