Incidence of treatment intensification based on HbA1c trends in people with type 2 diabetes

Clinical inertia, the failure to intensify treatment despite unmet glycemic goals, is a key factor in poor glycemic management for type 2 diabetes. No studies have defined clinical inertia based on HbA1c trends. In this study, we aimed to assess treatment intensification according to HbA1c trends.

We analyzed data from the Japan Diabetes Comprehensive Database Project based on an Advanced Electronic Medical Record System (J-DREAMS) between 2016 and 2023. Eligible patients with type 2 diabetes had (1) unchanged prescriptions for the past 90 days; (2) two consecutive consultations within 90 days; and (3) HbA1c levels ≥7%, or ≥7.5%, for patients aged ≥65 years at both consultations. Treatment intensification was defined as an addition or increased dose or switch in antidiabetic medications, inclusive of insulin, at the second consultation. Moreover, factors associated with treatment intensification were assessed.

Of the 5,683 patients, 1,130 (19.9%) received intensified treatment at the second consultation. Intensification occurred more frequently with higher HbA1c levels or worsening HbA1c trends. However, treatments were not intensified in approximately 50% of the patients, with HbA1c levels >8% or a worsening of >1%. Predictive factors included the HbA1c levels at the second consultation, changes in the HbA1c levels between the first and second consultations, the number of oral hypoglycemic medications, and the use of sulfonylureas or glinides.

Physicians should consider HbA1c trends to guide treatment intensification when HbA1c levels exceed target thresholds. Clinical inertia remains an important issue in diabetes management.