title: Intensification of Diabetes Therapy and Time Until A1C Goal Attainment Among Patients With Newly Diagnosed Type 2 Diabetes Who Fail Metformin Monotherapy Within a Large Integrated Health System.
abstract: "Clinical inertia" has been used to describe the delay in the intensification of type 2 diabetes treatment among patients with poor glycemic control. Previous studies may have exaggerated the prevalence of clinical inertia by failing to adequately monitor drug dose changes and nonmedication interventions. This project evaluated the intensification of diabetes therapy and hemoglobin A1c (A1C) goal attainment among patients with newly diagnosed type 2 diabetes when metformin monotherapy failed.
  
  
  
  The electronic health record at Cleveland Clinic was used to identify patients with newly diagnosed type 2 diabetes between 2005 and 2013 who failed to reach the A1C goal after 3 months of metformin monotherapy. A time-dependent survival analysis was used to compare the time until A1C goal attainment in patients who received early intensification of therapy (within 6 months of metformin failure) or late intensification. The analysis was performed for A1C goals of 7% (n = 1,168), 7.5% (n = 679), and 8% (n = 429).
  
  
  
  Treatment was intensified early in 62%, 69%, and 72% of patients when poor glycemic control was defined as an A1C >7%, >7.5%, and >8%, respectively. The probability of undergoing an early intensification was greater the higher the A1C category. Time until A1C goal attainment was shorter among patients who received early intensification regardless of the A1C goal (all P < 0.05).
  
  
  
  A substantial number of patients with newly diagnosed type 2 diabetes fail to undergo intensification of therapy within 6 months of metformin monotherapy failure. Early intervention in patients when metformin monotherapy failed resulted in more rapid attainment of A1C goals.
authors: Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH pantalk@ccf.org.
authors: Kevin M
authors: KM
authors: Pantalone
authors: Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, NC.
authors: Brian J
authors: BJ
authors: Wells
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors: Kevin M
authors: KM
authors: Chagin
authors: Merck & Co., Kenilworth, NJ.
authors: Flavia
authors: F
authors: Ejzykowicz
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors: Changhong
authors: C
authors: Yu
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors: Alex
authors: A
authors: Milinovich
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors: Janine M
authors: JM
authors: Bauman
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors: Michael W
authors: MW
authors: Kattan
authors: Merck & Co., Kenilworth, NJ.
authors: Swapnil
authors: S
authors: Rajpathak
authors: Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH.
authors: Robert S
authors: RS
authors: Zimmerman
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D057286:Electronic Health Records; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects*; D006040:Goals; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000209:etiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D008687:Metformin / Q000008:administration & dosage*; D008875:Middle Aged; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D017211:Treatment Failure
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin; C517652:hemoglobin A1c protein, human