Factors associated with clinical inertia in type 2 diabetes mellitus patients treated with metformin monotherapy

Abstract

Aims: To assess demographic and clinical characteristics associated with clinical inertia in a real-world cohort of type 2 diabetes mellitus patients not at hemoglobin A1c goal (<7%) on metformin monotherapy.

Methods: Adult (≥18?years) type 2 diabetes mellitus patients who received care at Massachusetts General Hospital/Brigham and Women’s Hospital and received a new metformin prescription between 1992 and 2010 were included in the analysis. Clinical inertia was defined as two consecutive hemoglobin A1c measures ≥7% ≥3?months apart while remaining on metformin monotherapy (i.e. without add-on therapy). The association between clinical inertia and demographic and clinical characteristics was examined via logistic regression.

Results: Of 2848 eligible patients, 43% did not achieve a hemoglobin A1c goal of <7% 3?months after metformin monotherapy initiation. A sub-group of 1533 patients was included in the clinical inertia analysis, of which 36% experienced clinical inertia. Asian race was associated with an increased likelihood of clinical inertia (OR?=?2.43; 95% CI?=?1.48–3.96), while congestive heart failure had a decreased likelihood (OR?=?0.58; 95% CI?=?0.32–0.98). Chronic kidney disease and cardiovascular/cerebrovascular disease had weaker associations but were directionally similar to congestive heart failure.

Conclusions: Asian patients were at an increased risk of clinical inertia, whereas patients with comorbidities appeared to have their treatment more appropriately intensified. A better understanding of these factors may inform efforts to decrease the likelihood for clinical inertia.