Clinical inertia in patients with type 2 diabetes: A retrospective cohort study using an electronic healthcare...

To describe clinical inertia in type 2 diabetes treatment in Japan using a large electronic healthcare database.

This retrospective new user cohort study used electronic medical records from the Health, Clinic, and Education Information Evaluation Institute database. Patients aged ≥18 years with type 2 diabetes receiving initial oral antidiabetic monotherapy between April 2014 and August 2022 were included. Clinical inertia was defined as the absence of treatment intensification for 180 days after HbA1c first exceeded 7%, unless HbA1c subsequently decreased to <7% during this period.

Of 20,948 patients in the full analysis set, 10,084 with follow-up of ≥180 days were evaluable for clinical inertia. Clinical inertia occurred in 56.9%, with higher rates in elderly patients (65-74 years: 60.0%; ≥75 years: 64.3%) and those on monotherapy (60.7%). Median time to the composite endpoint of treatment intensification or achievement of HbA1c <7% was 12 weeks overall. When treatment intensification alone was considered, the median time to intensification was 42 weeks.

Clinical inertia occurred in 56.9% of Japanese patients receiving initial monotherapy, with higher rates in elderly patients and those remaining on monotherapy. The median time to treatment intensification was 42 weeks, which may better reflect treatment patterns in routine clinical practice in Japan.