OBJECTIVES: Therapeutic inertia, defined as failure to intensify or reduce therapy where appropriate, can negatively impact diabetes clinical outcomes. This real-world study examined patterns of treatment intensification and modification in adults with uncontrolled type 2 diabetes (T2D) in the UK.

METHODS: This retrospective cohort analysis used data from the UK Clinical Practice Research Datalink (CPRD) and linked datasets from 01 January 2012 to 31 March 2020. The study population comprised insulin-naive adults(≥ 18 years)with T2D who had their first recorded uncontrolled HbA_1c of ≥7.5% (index event) by March 2019. These individuals were receiving treatment with non-insulin glucose-lowering agents – either an injectable glucagon-like peptide-1 receptor agonist (GLP-1 RA) or >1 oral antidiabetic drugs (OADs) – at and prior to the index uncontrolled HbA_1c measurement. Timely treatment intensification was defined as the initiation of GLP-1 RA or insulin or an increase in the number of OADs within 12 months post-index event.

RESULTS: Data were analysed from 38,965 individuals with uncontrolled T2D (mean [standard deviation] values at index: HbA_1c: 8.45% [1.21]; age: 66.4 years [11.9]; diabetes duration: 10.5 years [4.8]; body mass index: 31.5 kg/m² [6.5]). Of the total cohort, 70.9% (n=27,635) experienced a delay in treatment intensification. Among these, 88.9% (n=24,562) had no change in treatment, and 11.1% (n=3,073) had a non-intensification change, defined as the discontinuation of either GLP-1 RA or ≥1 OADs within 12 months of the index event. Overall, 29.1% (n=11,330) of the total cohort received timely intensification; 15.4% (n=1,747) initiated insulin, and 84.6% (n=9,583) either initiated GLP-1 RA or had an increase in the number of OADs compared with the pre-index period.

CONCLUSIONS: Based on this real-world analysis of UK clinical practice data, therapeutic inertia was common in the management of T2D, with almost three-quarters of individuals not receiving treatment intensification in the 12 months after an initial uncontrolled HbA_1c measurement.