A Multicenter Italian Survey on Diabetes Care Units Reveals a Somewhat Slow Attitude in Treatment Guideline Implementation: Are We Dealing With Therapeutic Inertia?

Abstract

Aim: Current guidelines suggest pursuing optimal metabolic management ever since the onset of type 2 diabetes mellitus (T2DM). Nevertheless, over 50% Italian patients fail to meet expected metabolic targets. The aim of our observational, multicenter study was to check whether this might at least partially depend on therapeutic inertia by verifying how diabetologists modified drug regimens of patients referring to them for the first time. Material and Methods: Two-thousand one hundred and eighty-eight people with T2DM aged ≥18 years and displaying a glycated hemoglobin (HbA1c) >7% (>53 mmol/mol) were analyzed at the time of their first visit at the Diabetes Care Unit (DCU). They reported no history of cardiovascular disease, were on oral hypoglycemic agents (OHA) and had clinical records available for at least the last 3 months. Results: The most relevant findings were the following: 70.3% patients underwent treatment changes after the first visit while only 0.4% had their previous drugs withdrawn. 29.7% people, however, were kept on the same regimens despite high HbA1c values and specialists reduced sulfonylurea (SU) prescriptions by only 4.3% and started insulin only in 3.8% patients, despite people with HbA1C >8% were as many as 58%. Conclusion: Even diabetologists were insufficiently fast and aggressive at intensifying glucose lowering treatment and in fact therapeutic inertia often prevented them from following best practice recommendations since the first visit. Specific actions have to be devised and readily taken against it to homogeneously improve diabetes outcomes by preventing unpredictably differentiated approaches from patient to patient. Better tools and greater resources allowing safer intensive glucose lowering strategies may also help specialists implement best practices.