Reasons for non-intensification of treatment in people with type 2 diabetes receiving oral monotherapy: Outcomes from the prospective DIAttitude study

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• 作者：Beverley Balkau^a ; ^{beverley.balkau@inserm.fr} ; Serge Halimi^b ; Jean-Fré ; dé ; ric Blickle^c ; Bruno Vergè ; s^d ; Antoine Avignon^e ; Claude Attali^f ; Isabelle Chartier^g ; Elisabeth Amelineau^h
• 关键词：Clinical inertia ; HbA1c ; Oral glucose-lowering medication ; Pharmacoepidemiology ; Treatment intensification ; Type 2 diabetes
• 刊名：Annales d'Endocrinologie
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：77
• 期：6
• 页码：649-657
• 全文大小：773 K
• 卷排序：77

文摘

To describe the management of glucose-lowering agents in people with type 2 diabetes initially on oral monotherapy, cared for by French general practitioners, and to identify reasons underlying treatment non-intensification.MethodsPeople with type 2 diabetes on oral monotherapy were recruited by general practitioners and followed-up over 12 months. Patient characteristics, HbA1c, and glucose-lowering treatments were recorded electronically. Management objectives and reasons for treatment non-intensification were solicited from the general practitioners.ResultsA total of 1212 patients were enrolled by 198 general practitioners; 937 patients (mean age 68 years) were treated with oral monotherapy, and 916 patients had at least two successive HbA1c values recorded. Of these, 390 patients (43%) had HbA1c ≥ 6.5% on both occasions, and 164/390 (42%) had their treatment intensified. The 226 patients whose treatment was not intensified were older (69 ± 11 years vs. 66 ± 12 years, P = 0.02) and had better glycaemic control at study inclusion (6.9% ± 0.6 vs. 7.3% ± 0.8, P < 0.0001) than treatment intensified patients. Among uncontrolled patients, there were no differences in general practitioner treatment objectives at inclusion for treatment intensified and non-intensified patients; the main reason given by general practitioners for non-intensification was that the patient had an adequate HbA1c (66%). HbA1c did exceed the 6.5% target, but was less than 7.0% in 69% of cases.ConclusionsGeneral practitioners showed a patient-centred approach to treatment, but clinical inertia was apparent for 31% of the uncontrolled patients.