José Miguel González-Clemente1, Beatriu Font2, Raquel Lahoz2, Gemma Llauradó3, Gemma Gambús2. 1. Servicio de Diabetes, Endocrinología y Nutrición, Hospital de Sabadell, Corporación Sanitaria Parc Taulí, Instituto Universitario Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España. Electronic address: jmgonzalez@tauli.cat. 2. Novartis Farmacéutica S. A., Barcelona, España. 3. Servicio de Diabetes, Endocrinología y Nutrición, Hospital de Sabadell, Corporación Sanitaria Parc Taulí, Instituto Universitario Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España.
Abstract
BACKGROUND AND OBJECTIVE: To study clinical inertia in the management of oral hypoglycemic agents (OHA) in non-insulin treated patients with type 2 diabetes mellitus (T2DM) in Spain. PATIENTS AND METHOD: Epidemiological, cross-sectional, retrospective (2 years), multicenter study. Clinical inertia was measured as the total number of patients without OHA treatment intensification divided by the total number of patients with inadequate HbA1c values (≥7%), multiplied by 100. Total clinical inertia (TCI) was the absence of OHA treatment intensification in all visits with a HbA1c≥7% values in the previous 2 years; partial clinical inertia (PCI) occurred when this absence only occurred in some of these visits. We assessed OHA treatment compliance with the Morisky-Green test. RESULTS: We included 2,971 patients, 1,416 adequately controlled (HbA1c<7%) and 1,555 inadequately controlled (HbA1c≥7%). PCI prevalence was 52.5%(95% confidence interval [95% CI] 52.4-52.6%) while TCI prevalence was 12.8% (95% CI 12.2-13.8%). PCI was lower in patients adequately controlled as compared with those inadequately controlled (31.4% vs. 71.8%; P<.001). PCI was associated with sedentary lifestyle, hypertension and higher prevalence of micro and macrovascular complications. Only 38.0% of patients were compliant with the OHA treatment, being this percentage even lower in subjects with ICP. Two variables were independently associated with ICP: female sex (odds ratio [OR] 1.43; 95% CI 1.09-1.86%) and a shorter duration of DM2 (OR 0.98; 95% CI 0.95-0.99). CONCLUSIONS: One out of 2 patients with T2DM and treated with OHA without insulin suffer from PCI. Only 4 out of 10 patients are compliant with OHA treatment. Female sex and a shorter duration of T2DM are independently associated with PCI.
BACKGROUND AND OBJECTIVE: To study clinical inertia in the management of oral hypoglycemic agents (OHA) in non-insulin treated patients with type 2 diabetes mellitus (T2DM) in Spain. PATIENTS AND METHOD: Epidemiological, cross-sectional, retrospective (2 years), multicenter study. Clinical inertia was measured as the total number of patients without OHA treatment intensification divided by the total number of patients with inadequate HbA1c values (≥7%), multiplied by 100. Total clinical inertia (TCI) was the absence of OHA treatment intensification in all visits with a HbA1c≥7% values in the previous 2 years; partial clinical inertia (PCI) occurred when this absence only occurred in some of these visits. We assessed OHA treatment compliance with the Morisky-Green test. RESULTS: We included 2,971 patients, 1,416 adequately controlled (HbA1c<7%) and 1,555 inadequately controlled (HbA1c≥7%). PCI prevalence was 52.5%(95% confidence interval [95% CI] 52.4-52.6%) while TCI prevalence was 12.8% (95% CI 12.2-13.8%). PCI was lower in patients adequately controlled as compared with those inadequately controlled (31.4% vs. 71.8%; P<.001). PCI was associated with sedentary lifestyle, hypertension and higher prevalence of micro and macrovascular complications. Only 38.0% of patients were compliant with the OHA treatment, being this percentage even lower in subjects with ICP. Two variables were independently associated with ICP: female sex (odds ratio [OR] 1.43; 95% CI 1.09-1.86%) and a shorter duration of DM2 (OR 0.98; 95% CI 0.95-0.99). CONCLUSIONS: One out of 2 patients with T2DM and treated with OHA without insulin suffer from PCI. Only 4 out of 10 patients are compliant with OHA treatment. Female sex and a shorter duration of T2DM are independently associated with PCI.
Keywords:
Clinical inertia; Diabetes tipo 2; Glycosylated haemoglobin; Hemoglobina glucosilada; Inercia clínica; Morisky-Green test; Test de Morisky-Green; Type 2 diabetes
Authors: Mark E Murphy; Molly Byrne; Atieh Zarabzadeh; Derek Corrigan; Tom Fahey; Susan M Smith Journal: Implement Sci Date: 2017-09-16 Impact factor: 7.327
Authors: Mark E Murphy; Jenny McSharry; Molly Byrne; Fiona Boland; Derek Corrigan; Paddy Gillespie; Tom Fahey; Susan M Smith Journal: BMJ Open Date: 2020-02-12 Impact factor: 2.692
Authors: Mark E Murphy; Molly Byrne; Fiona Boland; Derek Corrigan; Paddy Gillespie; Tom Fahey; Susan M Smith Journal: Pilot Feasibility Stud Date: 2018-10-13
Authors: Domingo Orozco-Beltrán; Manel Mata-Cases; Sara Artola; Pedro Conthe; Javier Mediavilla; Carlos Miranda Journal: Aten Primaria Date: 2016-01-13 Impact factor: 1.137