Endocrine Abstracts

Introduction: Clinical inertia applied to type2 Diabetes Mellitus (T2DM) treatment, is defined as a lack of treatment’s intensification of patients who are not in HbA1c target. Clinical inertia leads to a postponement of new therapeutic introduction, with all complications associated with a poor metabolic control. In Portugal there are only studies that show good or poor metabolic control but do not mention clinician’s attitude towards these values. Recently published international studies reveal partial clinical inertia in 52.5% of cases and full clinical inertia in 12.8%.

Objective: To evaluate clinical inertia of T2DM’s treatment in an Endocrinology department.

Methods: Cross-sectional, retrospective study of a random sample of patients with non-insulin treated T2DM, with minimum 12 months follow-up, during 2014–2015. It was established individualized HbA1c target based on patients’ characteristics: life expectancy,hypoglycemia, cardiovascular disease or other comorbidities. Total clinical inertia was defined as no treatment’s intensification at every visit and partial clinical inertia in at least one visit.

Results: We analyzed 317 patients, 73.9% male, 69.4±9.8 years, T2DM diagnosed for 11.5±8.7 years. 4.7% of patients had T2DM without treatment, 34.7% were treated with one non-insulinic antidiabetic drug (ANI), 38.5% with two ANI, 19.6% with three ANI, 2.2% with four ANI. It was established target HbA1c of 6.5% in 13.9% of patients; 7% in 48.9%; 7.5% in 30.9%; 8% in 5.6%. One hundred and twelve patients (35.3%) had HbA1c above target in at least one visit. Of these, there was total clinical inertia in 2.7% and partial inertia in 38.3%. HbA1c value was 0.1–0.5% higher than target in 65.6%; 0.6–1.0% in 17%; >1% at 13.8%. In subsequent visit, 43.8% recovered their HbA1c target, 38.1% had therapeutic intensification and 28.1% remained with clinical inertia.

Conclusion: The value of clinical inertia in our service was lower than described in literature and was associated with HbA1c values close to established target.