title: Reasons for non-intensification of treatment in people with type 2 diabetes receiving oral monotherapy: Outcomes from the prospective DIAttitude study.
abstract: OBJECTIVE
  To describe the management of glucose-lowering agents in people with type 2 diabetes initially on oral monotherapy, cared for by French general practitioners, and to identify reasons underlying treatment non-intensification.
  
  
  METHODS
  People with type 2 diabetes on oral monotherapy were recruited by general practitioners and followed-up over 12 months. Patient characteristics, HbA1c, and glucose-lowering treatments were recorded electronically. Management objectives and reasons for treatment non-intensification were solicited from the general practitioners.
  
  
  RESULTS
  A total of 1212 patients were enrolled by 198 general practitioners; 937 patients (mean age 68 years) were treated with oral monotherapy, and 916 patients had at least two successive HbA1c values recorded. Of these, 390 patients (43%) had HbA1c≥6.5% on both occasions, and 164/390 (42%) had their treatment intensified. The 226 patients whose treatment was not intensified were older (69±11 years vs. 66±12 years, P=0.02) and had better glycaemic control at study inclusion (6.9%±0.6 vs. 7.3%±0.8, P<0.0001) than treatment intensified patients. Among uncontrolled patients, there were no differences in general practitioner treatment objectives at inclusion for treatment intensified and non-intensified patients; the main reason given by general practitioners for non-intensification was that the patient had an adequate HbA1c (66%). HbA1c did exceed the 6.5% target, but was less than 7.0% in 69% of cases.
  
  
  CONCLUSIONS
  General practitioners showed a patient-centred approach to treatment, but clinical inertia was apparent for 31% of the uncontrolled patients.
authors.affiliation: Inserm U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ-UPS, 94807 Villejuif, France. Electronic address: beverley.balkau@inserm.fr.
authors.forename: Beverley
authors.initials: B
authors.lastname: Balkau
authors.affiliation: Université Grenoble Alpes (UJF), 38043 Grenoble, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Halimi
authors.affiliation: Hôpitaux Universitaires, 67000 Strasbourg, France.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Blickle
authors.affiliation: CHU de Dijon, 21079 Dijon, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vergès
authors.affiliation: CHU de Montpellier, 34000 Montpellier, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Avignon
authors.affiliation: Université Paris Est, Faculté de Médecine, 94010 Créteil, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Attali
authors.affiliation: Aixial-Pharma, 92300 Levallois-Perret, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Chartier
authors.affiliation: Bristol-Myers Squibb, 92500 Rueil-Malmaison, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Amelineau
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D058005:General Practitioners / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents
keywords: Clinical inertia; Diabète de type 2; HbA1c; Inertie thérapeutique; Intensification du traitement; Médicaments hypoglycémiants oraux; Oral glucose-lowering medication; Pharmaco-épidémiologie; Pharmacoepidemiology; Treatment intensification; Type 2 diabetes