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Extent of therapeutic inertia across the world – a systematic review
Therapeutic inertia, defined as the failure to initiate or intensify therapy according to evidence-based clinical guidelines, is an important reason for suboptimal glycaemic control in patients with type 2 diabetes. Members of the DISCOVER Scientific Committee conducted a systematic literature review to assess the extent of therapeutic inertia worldwide; results from this review have recently been published in Diabetes, Obesity and Metabolism.
A total of 53 articles published between 1 January 2004 and 1 August 2016 reported data on therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes. Measures and definitions varied greatly across studies, which precluded meta-analysis. However, the review showed the following.
Of note, some studies reported that some patients had HbA1c levels above target for several years before receiving treatment intensification (Figure). Given the risk of microvascular and macrovascular complications associated with poor glycaemic control, actions are required to increase adherence to guidelines and reduce therapeutic inertia.
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Figure. Glycaemic burden (length of time with an HbA1c level over target before treatment intensification) from selected studies