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

• Published in: Annales d'endocrinologie 2016-12, Vol.77 (6), p.649-657
• Main Authors: Balkau, Beverley, Halimi, Serge, Blickle, Jean-Frédéric, Vergès, Bruno, Avignon, Antoine, Attali, Claude, Chartier, Isabelle, Amelineau, Elisabeth
• Format: Article
• Language: English
• Subjects: Clinical inertia; Diabète de type 2; Endocrinology & Metabolism; Endocrinology and metabolism; HbA1c; Human health and pathology; Inertie thérapeutique; Intensification du traitement; Internal Medicine; Life Sciences; Médicaments hypoglycémiants oraux; Oral glucose-lowering medication; Pharmaceutical sciences; Pharmaco-épidémiologie; Pharmacoepidemiology; Pharmacology; Treatment intensification; Type 2 diabetes
• ISSN: 0003-4266; 2213-3941
• DOI: 10.1016/j.ando.2016.03.001

Abstract Objectives 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. Methods People 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. Results A 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. Conclusions General practitioners showed a patient-centred approach to treatment, but clinical inertia was apparent for 31% of the uncontrolled patients.