Evidence map›Paper›PMID 26743666›Full record

ArticleDiabetes, obesity & metabolism2016

Clinical inertia with regard to intensifying therapy in people with type 2 diabetes treated with basal insulin.

K Khunti, A Nikolajsen, B L Thorsted, M Andersen, M J Davies, S K Paul

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Diabetes, obesity & metabolism, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 144 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
144citing papers in PubMed, 6 pooled it
30.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

144 citing papers in PubMed, 6 syntheses or guidelines pooled it, 249 citations in OpenAlex.

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84 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 3 countries.

K KhuntiDiabetes Research Centre, University of Leicester, Leicester, UK.
A NikolajsenNovo Nordisk A/S, Søborg, Denmark.
B L ThorstedNovo Nordisk A/S, Søborg, Denmark.
M AndersenStatGroup ApS, Copenhagen, Denmark.
M J DaviesDiabetes Research Centre, University of Leicester, Leicester, UK.
S K PaulClinical Trials & Biostatistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
Novo Nordisk (Denmark) · DKUniversity of Leicester · GBQIMR Berghofer Medical Research Institute · AUStatistics Denmark · DK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimTo investigate whether clinical inertia, the failure to intensify treatment regimens when required, exists in people with type 2 diabetes treated with basal insulin.

methodsThis was a retrospective cohort study involving patients with type 2 diabetes in the UK Clinical Practice Research Datalink database between January 2004 and December 2011, with follow-up until December 2013.

resultsA total of 11 696 patients were included in the analysis. Among all patients, 36.5% had their treatment intensified during the study period; of these, the treatment of 50.0, 42.5 and 7.4% was intensified with bolus or premix insulin or glucagon-like peptide-1 receptor agonists, respectively. The median time from initiation of basal insulin to treatment intensification was 4.3 years [95% confidence interval (CI) 4.1, 4.6]. Among patients clinically eligible for treatment intensification [glycated haemoglobin (HbA1c) ≥7.5% (58 mmol/mol)], 30.9% had their treatment regimen intensified. The median time to intensification in this group was 3.7 years (95% CI 3.4, 4.0). Increasing age, duration of diabetes, oral antihyperglycaemic agent usage and Charlson comorbidity index score were associated with a significant delay in the time to intensification (p < 0.05). Among patients with HbA1c ≥7.5% (58 mmol/mol), 32.1% stopped basal insulin therapy.

conclusionsStrategies should be developed to increase the number of patients undergoing therapy intensification and to reduce the delay in intensifying therapy for suitable patients on basal insulin. Initiatives to support patients continuing on insulin are also required.

Indexed as

Glucagon-Like Peptide-1 Receptor AgonistsPractice Patterns, Physicians'AgedCohort StudiesDiabetes ComplicationsDiabetes Mellitus, Type 2Drug MonitoringDrug Therapy, CombinationFemaleFollow-Up StudiesGlucagon-Like Peptide-1 ReceptorGlycated HemoglobinHumansHyperglycemiaHypoglycemic AgentsInsulinGlucagon-Like Peptide-1 ReceptorGlucagon-Like Peptide-1 Receptor AgonistsGlycated Hemoglobinhemoglobin A1c protein, humanHypoglycemic AgentsInsulinbasalglucagon-like peptide-1glycaemic controlintensive insulin therapytype 2 diabetes

Identifiers

PMID26743666
PMCPMC5067688
OpenAlexW2226954704

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.