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

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Issued Date

2017

Resource Type

Article

File Type

application/pdf

ISSN

17530393

DOI

10.1111/1753-0407.12410

Other identifier(s)

2-s2.0-84979238875

Rights Holder(s)

Scopus

Bibliographic Citation

Journal of Diabetes. Vol 9, No.3 (2017), p.267-274

Suggested Citation

Osataphan S., Chalermchai T., Ngaosuwan K. Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: A retrospective cohort study. Journal of Diabetes. Vol 9, No.3 (2017), p.267-274. doi:10.1111/1753-0407.12410 Retrieved from: https://hdl.handle.net/20.500.14740/4219

Title

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

Author(s)

Osataphan S.
 Chalermchai T.
 Ngaosuwan K.

Abstract

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. © 2016 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd

Subject(s)

Alpha glucosidase inhibitor
 Dipeptidyl peptidase IV inhibitor
 Glitazone derivative
 Hemoglobin A1c
 Insulin
 Metformin
 Oral antidiabetic agent
 Sulfonylurea
 Antidiabetic agent
 Glycosylated hemoglobin
 Insulin
 Adult
 Aged
 Article
 Cohort analysis
 Controlled study
 Diabetic retinopathy
 Disease course
 Female
 Follow up
 General practitioner
 Glycemic control
 Human
 Incidence
 Major clinical study
 Male
 Non insulin dependent diabetes mellitus
 Retrospective study
 Risk factor
 Thailand
 Blood
 Complication
 Diabetes Mellitus, Type 2
 Diabetic retinopathy
 Metabolism
 Middle aged
 Statistical model
 Time factor
 University hospital
 Very elderly
 Adult
 Aged
 Aged, 80 and over
 Diabetes Mellitus, Type 2
 Diabetic Retinopathy
 Disease Progression
 Female
 Hemoglobin A, Glycosylated
 Hospitals, University
 Humans
 Hypoglycemic Agents
 Insulin
 Logistic Models
 Male
 Middle Aged
 Retrospective Studies
 Risk Factors
 Thailand
 Time Factors

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URI

https://hdl.handle.net/20.500.14740/4219

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Scopus: Year 1983-2021

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