Author’s Contribution: Effect of Delayed Treatment Intensification on Glycemic Control in the Real World

ERICAS Blog, March 19, 2019

A 2018 study of diabetes treatment patterns, conducted by a research team including Managing Principal Noam Kirson, Vice President Urvi Desai, and Associate Sarah King, has garnered international attention for its insights into the issue commonly known as “clinical inertia.”

Treatment guidelines for type 2 diabetes recommend starting with a single type of treatment (monotherapy) to achieve healthy blood glucose levels. If monotherapy fails to lower blood sugar levels, treatment can be intensified with the addition of other oral or injectable medications. However, patients and their health care providers often have negative perceptions towards intensifying treatment – an issue commonly known as “clinical inertia.” As a result, often there is an extended delay before people with type 2 diabetes receive intensified treatment, even when glucose levels remain elevated.

The 2018 research published in Diabetes Care comprised a retrospective cohort study of adults with type 2 diabetes in the UK. The research team found that earlier treatment intensification improved the likelihood of attaining desired glucose levels, of doing so sooner, and of maintaining these levels for longer periods of time.  

The research subsequently became the subject of an evidence summary in the BITE (Brokering Innovation Through Evidence) program of NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRCs), a collaboration between the UK’s National Health Service (NHS), universities, and local organizations.

The study’s results were also discussed in Diabetes Core Update, a monthly audio podcast devoted to presenting and discussing the latest clinically relevant articles from the American Diabetes Association’s scholarly journals.

In addition, the study received a five-star rating by ERICAS, an initiative by the University of Leicester Real World Evidence Unit that is dedicated to providing real world evidence on cardiometabolic medicine through review of published literature. Summarizing her research in an accompanying blog post for ERICAS, Dr. Desai concludes, “People with type 2 diabetes and their health care providers should consider discussing the potential benefits of intensified treatment early on in the treatment paradigm, and make the necessary adjustments in a timely manner.”

Read the study

Read the BITE evidence summary

Listen to the ADA podcast

View the ERICAS blog post



Kirson NDesai U