Clinical inertia in type 2 diabetes management in a middle-income country: A retrospective cohort study

Wan, Kim Sui and Moy, Foong Ming and Mohd Yusof, Khalijah and Mustapha, Feisul Idzwan and Mohd Ali, Zainudin and Hairi, Noran Naqiah Mohd (2020) Clinical inertia in type 2 diabetes management in a middle-income country: A retrospective cohort study. PLoS ONE, 15 (10). ISSN 1932-6203, DOI https://doi.org/10.1371/journal.pone.0240531.

Full text not available from this repository.

Abstract

Clinical inertia can lead to poor glycemic control among type 2 diabetes patients. However, there is paucity of information on clinical inertia in low- and middle-income countries including Malaysia. This study aimed to determine the time to treatment intensification among T2D patients with HbA1c of >= 7% (>= 53 mmol/mol) in Malaysian public health clinics. The proportion of patients with treatment intensification and its associated factors were also determined. Material and methods This was a five-year retrospective open cohort study using secondary data from the National Diabetes Registry. The study setting was all public health clinics (n = 47) in the state of Negeri Sembilan, Malaysia. Time to treatment intensification was defined as the number of years from the index year until the addition of another oral antidiabetic drug or initiation of insulin. Life table survival analysis based on best-worst case scenarios was used to determine the time to treatment intensification. Discrete-time proportional hazards model was fitted for the factors associated with treatment intensification. Results The mean follow-up duration was 2.6 (SD 1.1) years. Of 7,646 patients, the median time to treatment intensification was 1.29 years (15.5 months), 1.58 years (19.0 months) and 2.32 years (27.8 months) under the best-, average- and worst-case scenarios respectively. The proportion of patients with treatment intensification was 45.4% (95% CI: 44.2-46.5), of which 34.6% occurred only after one year. Younger adults, overweight, obesity, use of antiplatelet medications and poorer HbA1c were positively associated with treatment intensification. Patients treated with more oral antidiabetics were less likely to have treatment intensification. Conclusion Clinical inertia is present in the management of T2D patients in Malaysian public health clinics. We recommend further studies in lower- and middle-income countries to explore its causes so that targeted strategies can be developed to address this issue.

Item Type: Article
Funders: UNSPECIFIED
Uncontrolled Keywords: Treatment intensification; Therapy; People
Subjects: R Medicine
Divisions: Faculty of Medicine
Depositing User: Ms Zaharah Ramly
Date Deposited: 06 Oct 2023 03:54
Last Modified: 06 Oct 2023 03:54
URI: http://eprints.um.edu.my/id/eprint/36339

Actions (login required)

View Item View Item