Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Is medical inertia higher in the primary care treatment of young onset than middle age onset type 2 diabetes? (#335)

Griffiths Charmaine 1 2 , Timothy Middleton 1 2 , Yi Shi 1 2 , Belinda Brooks 1 3 , Ellen Landy 1 , Maria Constantino 1 2 , Ted Wu 1 , Jencia Wong 1 2 , Dennis Yue 1 2
  1. Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  2. Discipline of Medicine, University of Sydney, Sydney, NSW, Australia
  3. Sydney Nursing School, University of Sydney, Sydney, NSW, Australia

Doctors do not always up-titrate treatment of patients with type 2 diabetes even when hyperglycaemia is not adequately controlled.  This is often appropriate for clinical reasons but at other times it cannot be readily explained and this phenomenon has been referred to as “medical inertia”.  For biological and/or psycho-social reasons, it is often difficult to achieve good glycaemic control in patients with Young Onset Type 2 Diabetes (YT2DM,onset 15-30yrs).  In this study we examined whether a higher degree of “medical inertia” at the primary care level may also contribute to the poor glycaemic control of YT2DM.  We examined the electronic and paper records of 100 consecutive YT2DM (HbA1c 9.2±2.8%) to determine the medications prescribed by their primary care doctors at their first referral to our Diabetes Centre and compared it to 100 patients with Middle Age Onset Type 2 Diabetes (MT2DM, onset 40-50yrs, HbA1c 9.1±0.7%).  Medications were quantified as  number of agents or quantum of diabetes medications prescribed (one tablet of most usually prescribed strength arbitrarily considered as one quantum and any insulin treatment considered as 4 quanta).  Four MT2DM were excluded from analysis due to uncertainties about their data.  Results were analysed according to patients grouped by their duration of diabetes or HbA1c.  For either stratification, there was no difference in the prescribed treatment of YT2DM and MT2DM, but there was overall a significantly higher insulin usage for the YT2DM (p<0.01,Fig 1).  In the 23 YT2DM and 18 MT2DM patients with sufficient past information, their HbA1c at 6 months before referral were already elevated to 8.5±3.4 and 8.7±1.6% respectively. We conclude that whilst the glycaemic control of YT2DM is often suboptimal, it is not contributed by a higher “medical inertia” of the primary care physicians who are on average more proactive in instituting insulin treatment for YT2DM.  

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