Assessing the Effect of Clinical Inertia on Diabetes Outcomes: a Modeling Approach

• Published in: Journal of general internal medicine : JGIM 2019-03, Vol.34 (3), p.372-378
• Main Authors: Correa, Maria F., Li, Yan, Kum, Hye-Chung, Lawley, Mark A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood Glucose - drug effects; Blood Glucose - metabolism; Cardiovascular diseases; Clinical trials; Cohort Studies; Complications; Computer simulation; Delay; Diabetes; Diabetes Complications - blood; Diabetes Complications - drug therapy; Diabetes Complications - epidemiology; Diabetes mellitus; Diabetes Mellitus - blood; Diabetes Mellitus - drug therapy; Diabetes Mellitus - epidemiology; Diabetic nephropathy; Diabetic neuropathy; Disease Management; Female; Humans; Hypoglycemic Agents - pharmacology; Hypoglycemic Agents - therapeutic use; Incidence; Inertia; Internal Medicine; Long-term effects; Male; Medicine; Medicine & Public Health; Middle Aged; Models, Theoretical; Mortality; Nephropathy; Original Research; Patients; Population characteristics; Retinopathy; Young Adult
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-018-4773-3

Background There are an increasing number of newer and better therapeutic options in the management of diabetes. However, a large proportion of diabetes patients still experience delays in intensification of treatment to achieve appropriate blood glucose targets—a phenomenon called clinical inertia. Despite the high prevalence of clinical inertia, previous research has not examined its long-term effects on diabetes-related health outcomes and mortality. Objective We sought to examine the impact of clinical inertia on the incidence of diabetes-related complications and death. We also examined how the impact of clinical inertia would vary by the length of treatment delay and population characteristics. Design We developed an agent-based model of diabetes and its complications. The model was parameterized and validated by data from health surveys, cohort studies, and trials. Subjects We studied a simulated cohort of patients with diabetes in San Antonio, TX. Main Measures We examined 25-year incidences of diabetes-related complications, including retinopathy, neuropathy, nephropathy, and cardiovascular disease. Key Results One-year clinical inertia could increase the cumulative incidences of retinopathy, neuropathy, and nephropathy by 7%, 8%, and 18%, respectively. The effects of clinical inertia could be worse for populations who have a longer treatment delay, are aged 65 years or older, or are non-Hispanic whites. Conclusion Clinical inertia could result in a substantial increase in the incidence of diabetes-related complications and mortality. A validated agent-based model can be used to study the long-term effect of clinical inertia and, thus, inform clinicians and policymakers to design effective interventions.