Clinical Inertia in Patients with Type 2 diabetes in Nakonayok Hospital

Abstract

Background:   Clinical inertia is the main problem in the treatment of diabetics. This may cause the onset of diabetes complications faster.

Objective: To study 1) The incident of clinical inertia among patients with type2 diabetes treated with oral antidiabetic drugs 2) To measure time from treatment initiation to clinical inertia and to identify factors associated with clinical inertia and3) to measure time from treatment intensification and to identify factor associated with treatment intensification

Materials and Methods: This retrospective cohort study used electronic medical record of newly type 2 diabetic patient who diagnosed with  ICD10xxx and received medical treatments in Nakonayok Hospital  from January 1st, 2017 to December 31st ,2020 and follow-up treatments up to 2021. The data used were fasting blood sugar level and medications received visits to identify patients with clinical inertia, compare with the Clinical Practice Guideline for Diabetes 2019.

Result: The result show that of the 4302 new diabetes patients. The first clinical inertia was 13.88 %. The duration of clinical inertia is most commonly seen in the first  month after diagnosis.Factors associated with inertia were that an increase in age of 1 year is more likely to develop inertia than younger than 1 year of age HR_adj=4.30 (95% CI 3.21-5.76, P<0.01).Patients with comorbidities, hypertension, hyperlipidemia were less likely to develop clinical inertia than people with diabetes aloneHR_adj=0.49 (95% CI 0.37-0.65,P<0.01), HR_adj=0.50 (95% CI 0.38-0.66 P<0.01).The duration  of  treatment intensification is most commonly seen in the first  month after clinical inertia. Patients older than 1 year have the opportunity to receive additional medication than that of patients less than 1 year old HR_adj=1.32 (95% CI 1.15-1.52, P<0.01)

Conclusions: Clinical inertia is also a major problem in diabetes care, with aging increasingly likely to develop clinical inertia and an increased chance of receiving medication faster than younger patients.