Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: A retrospective cohort study

Abstract

Clinical inertia is a failure to intensified treatment according to evidence-based guidelines. Clinical inertia can have both short and long term adverse effects for type 2 diabetes.A retrospective cohort was performed using medical records at a university-based hospital in Thailand. Patients were classified into two groups, clinical inertia and non-inertia. Clinical inertia is defined as failure to initiate insulin within 3 months in patients with HbA1C ≥ 9% who were already taking two oral antidiabetic agents. Patients were recruited and followed during January 2010 to December 2014.From 1,206 records, 98 patients with mean HbA1C of 10.3% were enrolled and followed for a median time of 29.5 months. 68.4% were classified into the clinical inertia group. Mean HbA1C decrement ± SD in clinical inertia vs. non-inertia were 0.82 ± 1.5% vs. 3.02 ± 1.8% at 6 months (p < 0.001) and 1.46 ± 1.85% vs. 3.04 ± 1.76% at the end of study (p < 0.001). Clinical inertia has a significantly shorter median time to progression of diabetic retinopathy (log rank test, p = 0.02) and a higher incidence rate of diabetic retinopathy progression (10 vs. 2.2 cases per 1,000 person-months, p = 0.003). The adjusted incidence rate ratio for diabetic retinopathy progression in clinical inertia was 4.92 (95% CI; 1.11-21.77, p = 0.036). Being treated by general practitioners was the strongest associated risk factor for clinical inertia.Clinical inertia can cause persistently poor glycemic control and speed up the progression of diabetic retinopathy in type 2 diabetes. This article is protected by copyright. All rights reserved.