Factors associated with therapeutic inertia in individuals with type 2 diabetes mellitus started on basal insulin

Aim In this study we aim to identify the risk factors for treatment inertia in patients with type 2 diabetes mellitus (T2DM) who have been recently started on basal insulin (BI). Methods Using UK CPRD GOLD, we identified adults with T2DM with suboptimal glycaemia (HbA1c within 12 months of BI [≥]7% ([≥]53 mmol/mol)). We used multivariable Cox regression model to describe the association between patient characteristics and the time to treatment intensification. Results A total of 12,556 patients were analysed. Compared to individuals aged <65 years, those aged [≥]65 years had lower risk of treatment intensification (HR: 0.69; 95% CI: 0.64-0.73). Other risk factors included being female (0.93, 0.89-0.99), longer T2DM duration (0.99, 0.98-0.99), living in the most deprived areas (0.90, 0.83-0.98), being a current smoker (0.91, 0.84-0.98), having one (0.91, 0.85-0.97) or more than one comorbidity (0.88, 0.82-0.94), and patients who were on metformin (0.71, 0.63-0.80), or 2nd generation sulphonylureas (0.85; 0.79-0.92) or DPP4 inhibitors (0.87, 0.82-0.93) compared to those who were not. Conclusion Therapeutic inertia still remains a major barrier, with multiple factors associated with delay in intensification. Interventions to overcome therapeutic inertia need to be implemented at both patient and health care professional level. Keyword Basal insulin, type 2 diabetes mellitus, suboptimal glycaemic level, therapeutic inertia.

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