scholarly journals Therapeutic inertia in type 2 diabetes: prevalence, causes, consequences and methods to overcome inertia

2019 ◽  
Vol 10 ◽  
pp. 204201881984469 ◽  
Author(s):  
Sachin Khunti ◽  
Kamlesh Khunti ◽  
Samuel Seidu
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Healthcare Professionals ◽  
Microvascular Complications ◽  
Healthcare Systems ◽  
Treatment Intensification ◽  
Therapeutic Inertia ◽  
The Subject

Early glycaemic control leads to better outcomes, including a reduction in long-term macrovascular and microvascular complications. Despite good-quality evidence, glycaemic control has been shown to be inadequate globally. Therapeutic inertia has been shown present in all stages of treatment intensification, from the first oral antihyperglycaemic drug (OAD), all the way to the initiation of insulin. The causes and possible solutions to the problem of therapeutic inertia are complex but can be understood better when viewed from the perspective of the providers [healthcare professionals (HCPs)], patients and healthcare systems. In this review, we will discuss the possible aetiologies, consequences and solutions of therapeutic inertia, drawing upon evidence from published literature on the subject of type 2 diabetes.

scholarly journals Breaking Therapeutic Inertia in Type 2 Diabetes: Active Detection of In-Patient Cases Allows Improvement of Metabolic Control at Midterm

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Anna M. Lucas Martín ◽  
Elena Guanyabens ◽  
R. Zavala-Arauco ◽  
Joaquín Chamorro ◽  
Maria Luisa Granada ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Metabolic Control ◽  
Hospitalized Patients ◽  
Therapeutic Inertia ◽  
Therapeutic Algorithm ◽  
Fasting Glycaemia ◽  
Active Detection

Type 2 diabetes (T2D) exists in 25–40% of hospitalized patients. Therapeutic inertia is the delay in the intensification of a treatment and it is frequent in T2D. The objectives of this study were to detect patients admitted to surgical wards with hyperglycaemia (HH; fasting glycaemia > 140 mg/dL) as well as those with T2D and suboptimal chronic glycaemic control (SCGC) and to assess the midterm impact of treatment modifications indicated at discharge. A total of 412 HH patients were detected in a period of 18 months; 86.6% (357) had a diagnosed T2D. Their preadmittanceHbA1cwas 7.7 ± 1.5%; 47% (189) hadHbA1c≥ 7.4% (SCGC) and were moved to the upper step in the therapeutic algorithm at discharge. Another 15 subjects (3.6% of the cohort) had T2D according to their currentHbA1c. Ninety-four of the 189 SCGC patients were evaluated 3–6 months later. TheirHbA1cbefore in-hospital-intervention was 8.6 ± 1.2% and 7.5 ± 1.2% at follow-up (P<0.004). Active detection of hyperglycaemia in patients admitted in conventional surgical beds permits the identification of T2D patients with SCGC as well as previously unknown cases. A shift to the upper step in the therapeutic algorithm at discharge improves this control. Hospitalization is an opportunity to break therapeutic inertia.

scholarly journals Association of long-term glycaemic control on tear break-up times and dry eye symptoms in Chinese patients with type 2 diabetes

2018 ◽  
Vol 46 (6) ◽  
pp. 608-615 ◽  
Author(s):  
Andre Ma ◽  
Martin SY Mak ◽  
Kendrick Co Shih ◽  
Claudia KY Tsui ◽  
Rachel KY Cheung ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Dry Eye ◽  
Chinese Patients ◽  
Eye Symptoms ◽  
Break Up ◽  
Dry Eye Symptoms

scholarly journals Glycaemic control after treatment intensification in patients with type 2 diabetes uncontrolled on two or more non‐insulin antidiabetic drugs in a real‐world setting

2019 ◽  
Vol 21 (6) ◽  
pp. 1373-1380 ◽  
Author(s):  
Silvia Canivell ◽  
Manel Mata‐Cases ◽  
Jordi Real ◽  
Josep Franch‐Nadal ◽  
Bogdan Vlacho ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Real World ◽  
Antidiabetic Drugs ◽  
Treatment Intensification ◽  
Real World Setting

The overtreatment of type 2 diabetes in frail older people

2020 ◽  
Vol 2 (9) ◽  
pp. 496-502
Author(s):  
Hannah Syed
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Older People ◽  
Diabetes Management ◽  
Holistic Approach ◽  
Protective Effects ◽  
Frail Older People ◽  
Good Glycaemic Control

Intensive treatment with insulin and sulfonylureas in older people with low HbA1c (<53mmol/mol) can increase the risk of hypoglycaemia, morbidity and mortality. Older people, particularly those with frailty and/or comorbidities are less likely to benefit from the long-term protective effects of good glycaemic control and are often at risk of inappropriate polypharmacy. A person-centred holistic approach to diabetes management must be adapted for older people living with diabetes.

scholarly journals Selecting Core Outcomes for Randomised Effectiveness trials In Type 2 diabetes (SCORE-IT): a patient and healthcare professional consensus on a core outcome set for type 2 diabetes

2019 ◽  
Vol 7 (1) ◽  
pp. e000700 ◽  
Author(s):  
Nicola L Harman ◽  
John P H Wilding ◽  
Dave Curry ◽  
James Harris ◽  
Jennifer Logue ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Healthcare Professionals ◽  
Core Outcome Set ◽  
Consensus Meeting ◽  
Core Outcome ◽  
Outcome Set ◽  
Core Outcomes ◽  
Effectiveness Trials

ObjectivesHeterogeneity in outcomes measured across trials of glucose-lowering interventions for people with type 2 diabetes impacts on the ability to compare findings and may mean that the results have little importance to healthcare professionals and the patients that they care for. The SCORE-IT study (Selecting Core Outcomes for Randomised Effectiveness trials In Type 2 diabetes) has addressed this issue by establishing consensus on the most important outcomes for non-surgical interventions for hyperglycemia in type 2 diabetes.Research design and methodsA comprehensive list of outcomes was developed from registered clinical trials, online patient resources, qualitative literature and long-term studies in the field. This list was then scored in a two-round online Delphi survey completed by healthcare professionals, people with type 2 diabetes, researchers in the field and healthcare policymakers. The results of this online Delphi were discussed and ratified at a face-to-face consensus meeting.Results173 people completed both rounds of the online survey (116 people with type 2 diabetes, 37 healthcare professionals, 14 researchers and 6 policymakers), 20 of these attended the consensus meeting (13 people with type 2 diabetes and 7 healthcare professionals). Consensus was reached on 18 core outcomes across five domains, which include outcomes related to diabetes care, quality of life and long-term diabetes-related complications.ConclusionsImplementation of the core outcome set in future trials will ensure that outcomes of importance to all stakeholders are measured and reported, enhancing the relevance of trial findings and facilitating the comparison of results across trials.

Sodium–Glucose Co-transporter 2 Inhibition – A Novel Strategy for Glucose Control in Type 2 Diabetes

2010 ◽  
Vol 7 (1) ◽  
pp. 30
Author(s):  
Luke Norton ◽  
Ralph A DeFronzo ◽  
Muhammad A Abdul-Ghani ◽  
◽  
◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Beta Cell ◽  
Mechanism Of Action ◽  
Microvascular Complications ◽  
Oral Antidiabetic Agents ◽  
Oral Antidiabetic ◽  
Tissue Sensitivity ◽  
Novel Strategy

In addition to its central role in the development of microvascular complications, hyperglycaemia plays an important role in the pathogenesis of type 2 diabetes, i.e. glucotoxicity. Thus, effective glycaemic control not only reduces the incidence of microvascular complications, but also corrects the metabolic abnormalities that contribute to the progression of the disease. Progressive beta-cell failure and side effects associated with therapy, such as hypoglycaemia and weight gain, present obstacles to the achievement of optimal durable glycaemic control in subjects with type 2 diabetes. Most recently, inhibitors of the renal sodium glucose co-transporter have been developed to produce glucosuria and reduce the plasma glucose concentration. Because the mechanism of action of these oral antidiabetic agents is independent of beta-cell and tissue sensitivity to insulin, they improve glycaemic control while avoiding hypoglycaemia and promoting weight loss. In this article, we will summarise the available data concerning the mechanism of action, efficacy and safety of this novel antidiabetic therapeutic approach.

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