A cross-sectional survey to assess reasons for therapeutic inertia in people with type 2 diabetes mellitus and preferred strategies to overcome it from the perspectives of persons with diabetes and general/family practitioners: Results from the MOTION study

Introduction: Type 2 diabetes mellitus (T2DM) is a metabolic syndrome that is characterized by chronic hyperglycaemia, and can lead to chronic long-term complications. The prevalence of diabetes mellitus in Cameroon has been reported at 5.9% in 2017. Studies conducted in 2011, showed that only 41% of patients had a good glycaemic control which was, HbA1c < 6.5. The aim of this study was therefore to evaluate the treatment intensification with time in T2DM patients in the Yaoundé diabetic Centre in Cameroon. Methods: The study was a cross-sectional analytical study. In a group of T2DM patients followed up at the National Obesity Centre (NOC) with poorly controlled blood sugar (HbA1c ≥ 7%). The treatment intensification and outcome were evaluated between the periods January 2016 to April 2018. The data was collected from patients’ medical booklet and through a face-to-face interviewer-administered questionnaire. Results: One hundred and eleven patients (31 males, 27.9% and 80 females, 72.1%) were recruited. The mean age was between 59 ± 10 years and the mean duration of diabetes 8.6 ± 7.0 years. The patients’ treatment consisted: 1) oral anti-diabetic (OAD) agents, monotherapy (24.3%), bitherapy (28.8%), tritherapy 2.7%, 2) insulin only, 19.8% and 3) insulin mixture, 24.3%. The mean baseline HbA1c was 9.3 ± 2.0%. Within the given follow-up time of 16 [11-21] months, only 40 out of the 111 patients had their treatment intensified and 71 had no intensification (therapeutic inertia) despite poor HbA1c levels. Among the 40 with intensification, 5 had immediate intensification and the proportions according to intensification delay ≤3 months, 3-6 months, 6-12 months and >12 months . Conclusion: Therapeutic inertia affected two third of our population. Despite the high level of inertia, both patients with intensified treatment and non-intensified treatment reached treatment targets.

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Changes in hyperglycaemia-related testing for prediabetes and type 2 diabetes mellitus management: a prospective, cross-sectional survey of 16 years of general practice data from Australia

10.21203/rs.3.rs-874376/v1 ◽

2021 ◽

Author(s):

Andrew Leigh ◽

Jennifer Hunter ◽

Christopher Harrison ◽

Helena Britt ◽

Eugen Molodysky

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cluster Sampling ◽

Lifestyle Modifications ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Clinical Encounters ◽

Annual Trends

Abstract BackgroundThe rising prevalence of prediabetes increases the population risk of type 2 diabetes mellitus (T2DM), metabolic syndrome and cardiovascular disease. Early identification by General Practitioners (GPs) provides opportunities for lifestyle modifications that can lower these risks.MethodsThis study examined 16 years of annual trends (2000/01-20015/16) in hyperglycaemia-related testing for patients in Australia aged 13 years or older with, or at risk of a diagnosis of T2DM. The Bettering the Evaluation and Care of Health (BEACH) study is a national cross-sectional survey, with a single-stage, cluster sampling design. Approximately 1,000 GPs were randomly selected annually (2000/01-20015/16) from across Australia, who each recorded details of 100 consecutive clinical encounters with consenting patients. Means and 95% confidence intervals were adjusted for intracluster correlation and GP characteristics.Results15,679 GPs recorded details of 1,387,190 clinical encounters with patients aged 13+ years. Prediabetes and T2DM were managed at 0.25% (95% CI: 0.24-0.27%) and 3.68% (95% CI: 3.62-3.73%) of encounters respectively. By the end of the study, annual management rates were 2.3 times higher for prediabetes and 1.5 times for T2DM management. The likelihood of ordering at least one hyperglycaemia-related test during prediabetes management occasion was twice the likelihood in management of T2DM. For prediabetes, glucose tolerance tests were most common but from 2014/15, requests for HbA1c tests began to increase. For T2DM, HbA1c tests were most common, and requests for one or more glucose tests gradually declined.ConclusionThe observed 16-year annual trends align with the rising incidence of prediabetes and T2DM. GPs appeared to be strongly influenced by changes to the national insurance scheme and clinical guidelines for hyperglycaemia-related pathology testing. However, some GPs may have been pre-empting policy changes as there was also evidence of ‘unendorsed’ testing, notably for prediabetes that warrants further investigation. The increasing management rates for prediabetes, coupled with higher rates of pathology requesting have substantial resource implication. Calls to lower the risk threshold for prediabetes screening therefore warrant an economic analysis. Ongoing, reliable, up-to-date data is needed to inform clinical practice guidelines and policy in Australia.

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