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Clinical Inertia is Doubled in Patients of Asian Ethnicity with Type 2 Diabetes 

Oct 5, 2019
 
Editor: Steve Freed, R.PH., CDE

Author: Keri Hames, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences

Clinical inertia in Asian diabetes patients: study finds U.S. patients of Asian ancestry experience delays in treatment augmentation when they haven’t met the recommended hemoglobin A1c goals. 

The purpose of this study was to assess the association of clinical inertia with patients of different demographics and clinical characteristics who had type 2 diabetes.  Within this patient population, researchers wanted to investigate patients who were on metformin alone and haven’t obtained a hemoglobin A1c that is at goal (<7%). The researchers wanted to understand the reason for delayed treatment increases in patients with type 2 diabetes, since there has been research done stating that reaching glycemic control can reduce the risk of other complications in these patients.

 

In this study, researchers evaluated 1,533 electronic medical records of patients with type 2 diabetes who obtained care at Massachusetts General Hospital or Brigham and Women’s Hospital.  These patients must have received a new prescription of metformin between the years of 1992 to 2010, have at least 12 months of baseline data, and 18 months of follow-up records. Within this patient population, 52% of the patients were women, the mean age was 57 years old, and about 55% of them were white. The researchers defined clinical inertia as patients who reached two consecutive readings of HbA1c that measured >7% that are at least 3 months apart while being treated with metformin alone.  Those that are not experiencing clinical inertia include patients who have readings of  HbA1C >7% that are at least 3 months apart who have received add-on therapy for diabetes.  The statistical model that the researchers used was a logistic regression model to determine the association of clinical inertia, demographics, and clinical characteristics. 

Of the patients that had partaken in the study, 36% achieved clinical inertia.  Within this group of patients that experienced clinical inertia, the common comorbidities included: hypertension (68.1%), overweight or obesity (40.2%), and dyslipidemia (53.2%).  Asians were more likely to experience clinical inertia compared to those without clinical inertia (7.4% vs. 3.1%; P < 0.001). In this study, the researchers determined that Asians were at a high risk of clinical inertia (OR = 2.43; 95% CI, 1.48-3.96).  However, Asians were are at a lower risk of clinical inertia when it came to congestive heart failure (OR = 0.58; 95% CI, 0.32-0.98). There were weaker associations with chronic kidney, cardiovascular, and cerebrovascular diseases in respects to clinical inertia, but these diseases are directly similar to congestive heart failure, which was specified by the researchers. 

The researchers concluded that Asian patients are at higher risk of experiencing clinical inertia compared to other patients with comorbidities that had their treatment plans correctly exaggerated. Further studies should evaluate the better understanding of these factors to prevent clinical inertia from occurring as often in the Asian population. 

Practice Pearls:

  • Asian patients with type 2 diabetes are at an increased risk of clinical inertia compared to other patients with comorbidities that have their treatment regimen appropriately intensified.
  • Asian patients were at a lower risk of clinical inertia when related to congestive heart failure and type 2 diabetes.
  • Future studies should evaluate these factors to strengthen the prevention of clinical inertia in the Asian population.

U, Kartoun, and Res Opin. “Asian Race Doubles Risk for Clinical Inertia in Type 2 Diabetes.” Healio, www.healio.com/endocrinology/diabetes/news/online/{ad750f7c-60df-4697-8c6f-d25ce4dbfa05}/asian-race-doubles-risk-for-clinical-inertia-in-type-2-diabetes?M_BT=2469436429117.

“Factors Associated with Clinical Inertia in Type 2 Diabetes Mellitus Patients Treated with Metformin Monotherapy.” Taylor & Francis, www.tandfonline.com/doi/full/10.1080/03007995.2019.1648116?scroll=top&needAccess=true.

Keri Hames, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences