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Clinical Epidemiology and Ageing

Reasons for non-intensification of treatment in people with type 2 diabetes receiving oral monotherapy: Outcomes from the prospective DIAttitude study.

Balkau B, Halimi S, Blickle J-F, Vergès B, Avignon A, Attali C, Chartier I, Amelineau E Ann Endocrinol (Paris). 2016;77(6):649-657.

OBJECTIVES: To describe the management of glucose-lowering agents in people with type 2 diabetes initially on oral monotherapy, cared for by French general practitioners, and to identify reasons underlying treatment non-intensification.

METHODS: People with type 2 diabetes on oral monotherapy were recruited by general practitioners and followed-up over 12 months. Patient characteristics, HbA1c, and glucose-lowering treatments were recorded electronically. Management objectives and reasons for treatment non-intensification were solicited from the general practitioners.

RESULTS: A total of 1212 patients were enrolled by 198 general practitioners; 937 patients (mean age 68 years) were treated with oral monotherapy, and 916 patients had at least two successive HbA1c values recorded. Of these, 390 patients (43%) had HbA1c≥6.5% on both occasions, and 164/390 (42%) had their treatment intensified. The 226 patients whose treatment was not intensified were older (69±11 years vs. 66±12 years, P=0.02) and had better glycaemic control at study inclusion (6.9%±0.6 vs. 7.3%±0.8, P<0.0001) than treatment intensified patients. Among uncontrolled patients, there were no differences in general practitioner treatment objectives at inclusion for treatment intensified and non-intensified patients; the main reason given by general practitioners for non-intensification was that the patient had an adequate HbA1c (66%). HbA1c did exceed the 6.5% target, but was less than 7.0% in 69% of cases.

CONCLUSIONS: General practitioners showed a patient-centred approach to treatment, but clinical inertia was apparent for 31% of the uncontrolled patients.

MeSH terms: Administration, Oral; Adult; Aged; Aged, 80 and over; Attitude of Health Personnel; Diabetes Mellitus, Type 2; Dose-Response Relationship, Drug; Female; General Practitioners; Humans; Hypoglycemic Agents; Male; Middle Aged; Motivation; Practice Patterns, Physicians'; Treatment Outcome
DOI: 10.1016/j.ando.2016.03.001

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