Is therapeutic inertia present in primary diabetes care in Malaysia? A prospective study

Abstract

AbstractAimsThis prospective study aimed to determine the proportions of therapeutic inertia when treatment targets not achieved in adults T2D at three public health clinics in Malaysia.MethodsThe index prescriptions were those when the annual blood tests were reviewed. Prescriptions were verified and classified as 1) no change, 2) stepping up and 3) stepping down. Multivariable logistic regression and sensitive analyses were conducted.ResultsAt follow-up, 552 participants were available for the assessment of therapeutic inertia (78.9% response rate). The mean (SD) age and diabetes duration were 60.0 (9.9) years and 5.0 (6.0) years, respectively. High therapeutic inertia were observed in oral anti-diabetic (61-72%), anti-hypertensive (34-65%) and lipid-lowering therapies (56-77%), and lesser in insulin (34- 52%). Insulin therapeutic inertia was more likely among those with shorter diabetes duration (adjusted OR 0.9, 95% CI 0.87, 0.98). Those who did not achieve treatment targets were less likely to experience therapeutic inertia: HbA1c ≥ 7.0%: adjusted OR 0.10 (0.04, 0.24); BP ≥ 140/90 mmHg: 0.28 (0.16, 0.50); LDL-cholesterol ≥ 2.6 mmol/L: 0.37 (0.22, 0.64).ConclusionsAlthough therapeutic intensifications were more likely in the present of non- achieved treatment targets but the proportions of therapeutic inertia were high.Trial registrationNCT02730754 https://clinicaltrials.gov/ct2/show/NCT02730754HighlightsProbably the first study in Malaysia or Asian countriesAssessing three main therapeutic inertia among T2D at primary diabetes careProportions of therapeutic inertia were highTherapeutic inertia was unlikely in non-achieved treatment targetsPossible causes of therapeutic inertia require identification and rectification