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Assessing the Effect of Clinical Inertia on Diabetes Outcomes: a Modeling Approach
Maria F Correa1, Yan Li2,3, Hye-Chung Kum4,5,6
1Department of Psychiatry, The University of Texas at Austin Dell Medical School, Austin, TX, USA.
Background:
There are an increasing number of newer and better therapeutic options in the management of diabetes. However, a large proportion of diabetes patients still experience delays in intensification of treatment to achieve appropriate blood glucose targets-a phenomenon called clinical inertia. Despite the high prevalence of clinical inertia, previous research has not examined its long-term effects on diabetes-related health outcomes and mortality.
Objective:
We sought to examine the impact of clinical inertia on the incidence of diabetes-related complications and death. We also examined how the impact of clinical inertia would vary by the length of treatment delay and population characteristics.
Design:
We developed an agent-based model of diabetes and its complications. The model was parameterized and validated by data from health surveys, cohort studies, and trials.
Subjects:
We studied a simulated cohort of patients with diabetes in San Antonio, TX.
Main Measures:
We examined 25-year incidences of diabetes-related complications, including retinopathy, neuropathy, nephropathy, and cardiovascular disease.
Key Results:
One-year clinical inertia could increase the cumulative incidences of retinopathy, neuropathy, and nephropathy by 7%, 8%, and 18%, respectively. The effects of clinical inertia could be worse for populations who have a longer treatment delay, are aged 65 years or older, or are non-Hispanic whites.
Conclusion:
Clinical inertia could result in a substantial increase in the incidence of diabetes-related complications and mortality. A validated agent-based model can be used to study the long-term effect of clinical inertia and, thus, inform clinicians and policymakers to design effective interventions.
Insights
Clinical inertia, or delayed diabetes treatment intensification, significantly increases the risk of serious complications and mortality. This highlights the urgent need for interventions to improve blood glucose management in diabetes patients.
Area of Science:
- Endocrinology and Metabolism
- Health Services Research
- Computational Biology
Background:
- Despite advances in diabetes therapeutics, clinical inertia (delayed treatment intensification) is prevalent.
- Previous research has not fully explored the long-term consequences of clinical inertia on diabetes outcomes.
- Understanding these long-term effects is crucial for effective diabetes management strategies.
Purpose of the Study:
- To investigate the impact of clinical inertia on diabetes-related complications and mortality.
- To analyze how treatment delay duration and patient characteristics modify the effects of clinical inertia.
Main Methods:
- Development and validation of an agent-based model simulating diabetes and its complications.
- Parameterization and validation using data from health surveys, cohort studies, and clinical trials.
- Simulation of a 25-year period for a cohort of patients with diabetes in San Antonio, TX.
Main Results:
- One year of clinical inertia can elevate cumulative incidences of retinopathy (7%), neuropathy (8%), and nephropathy (18%).
- The adverse effects of clinical inertia are more pronounced in patients with longer treatment delays, older age (≥65 years), and non-Hispanic white populations.
- Clinical inertia is associated with a substantial increase in diabetes-related complications and mortality.
Conclusions:
- Clinical inertia poses a significant risk for increased diabetes-related complications and mortality.
- Agent-based modeling provides a valuable tool for assessing the long-term impact of clinical inertia.
- Findings can inform interventions for clinicians and policymakers to mitigate the effects of clinical inertia.
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