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Therapeutic inertia in type 2 diabetes mellitus: a fine line between advancing and de-intensifying

Type 2 diabetes mellitus is a progressive disease requiring regular monitoring and therapeutic changes. It is important that healthcare professionals embrace both ends of the spectrum of therapeutic inertia, including appropriate advancement and de-intensification of therapies.

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Fig. 1: Overcoming therapeutic inertia over the life course of a person with T2DM.

References

  1. Khunti, K., Kosiborod, M. & Ray, K. K. Legacy benefits of blood glucose, blood pressure and lipid control in individuals with diabetes and cardiovascular disease: time to overcome multifactorial therapeutic inertia? Diabetes Obes. Metab. 20, 1337–1341 (2018).

    Article  PubMed  Google Scholar 

  2. Mauricio, D. et al. Glycaemic control and hypoglycaemia burden in patients with type 2 diabetes initiating basal insulin in Europe and the USA. Diabetes Obes. Metab. 19, 1155–1164 (2017).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Khunti, K., Ceriello, A., Cos, X. & De Block, C. Achievement of guideline targets for blood pressure, lipid, and glycaemic control in type 2 diabetes: a meta-analysis. Diabetes Res. Clin. Pract. 137, 137–148 (2018).

    Article  PubMed  Google Scholar 

  4. Khunti, S., Khunti, K. & Seidu, S. Therapeutic inertia in type 2 diabetes: prevalence, causes, consequences and methods to overcome inertia. Ther. Adv. Endocrinol. Metab. 10, 2042018819844694 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Khunti, K. & Aroda, V. R. Coming full circle: prioritizing early glycemic control to reduce microvascular and macrovascular complications in people with type 2 diabetes. Diabetes Care 45, 766–768 (2022).

    Article  PubMed  Google Scholar 

  6. Wrzal, P. K. et al. Strategies to overcome therapeutic inertia in type 2 diabetes mellitus: a scoping review. Can. J. Diabetes 45, 273–281.e13 (2021).

    Article  PubMed  Google Scholar 

  7. Powell, R. E. et al. Strategies for overcoming therapeutic inertia in type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes. Metab. 23, 2137–2154 (2021).

    Article  CAS  PubMed  Google Scholar 

  8. Bain, S. C., Bekker Hansen, B., Hunt, B., Chubb, B. & Valentine, W. J. Evaluating the burden of poor glycemic control associated with therapeutic inertia in patients with type 2 diabetes in the UK. J. Med. Econ. 23, 98–105 (2020).

    Article  PubMed  Google Scholar 

  9. Ali, S. N., Dang-Tan, T., Valentine, W. J. & Hansen, B. B. Evaluation of the clinical and economic burden of poor glycemic control associated with therapeutic inertia in patients with type 2 diabetes in the United States. Adv. Ther. 37, 869–882 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Seidu, S. et al. Deintensification in older patients with type 2 diabetes: a systematic review of approaches, rates and outcomes. Diabetes Obes. Metab. 21, 1668–1679 (2019).

    Article  PubMed  Google Scholar 

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Acknowledgements

K.K. acknowledges the support of the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands and the NIHR Leicester Biomedical Research Centre.

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Correspondence to Kamlesh Khunti.

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K.K. has acted as a consultant, speaker or received grants for investigator-initiated studies for Astra Zeneca, Bayer, Novartis, Novo Nordisk, Sanofi-Aventis, Lilly and Merck Sharp & Dohme, Boehringer Ingelheim, Oramed Pharmaceuticals, Roche and Applied Therapeutics. K.K. is chair of the American Diabetes Association Therapeutic Inertia Initiative. A.Y.Y.C. declares no competing interests.

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Khunti, K., Cheng, A.Y.Y. Therapeutic inertia in type 2 diabetes mellitus: a fine line between advancing and de-intensifying. Nat Rev Endocrinol 19, 437–438 (2023). https://doi.org/10.1038/s41574-023-00857-w

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