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Asian race doubles risk for clinical inertia in type 2 diabetes
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Asian adults with type 2 diabetes were more than twice as likely as patients of other races to experience delayed treatment intensification when not meeting HbA1c goals, according to an analysis of electronic medical records data published in Current Medical Research and Opinion.
“The capabilities of electronic medical records (EMR) data, including automated processing of the textual component of clinical notes, enable a variety of real-world studies to be conducted that can lead to improved quality of care and patient health outcomes,” Uri Kartoun, PhD, a researcher with the Center for Computational Health at IBM Research in Cambridge, Massachusetts, and colleagues wrote in the study background. “Given evidence that optimizing glycemic control can reduce the risk for complications of [type 2 diabetes], the current study used information embodied in EMR — both structured and unstructured narrative data — to better understand the reasons for delayed treatment intensification (ie, clinical inertia) in a cohort of patients with [type 2 diabetes].”
Kartoun and colleagues analyzed data from 1,533 adult patients with type 2 diabetes (mean age, 57 years; 52% women; 55.3% white) who received care at Massachusetts General Hospital or Brigham and Women’s Hospital, had 12 months of baseline data and 18 months of follow-up medical records, and received a new metformin prescription between 1992 and 2010. The researchers defined clinical inertia as two consecutive HbA1c measurements of at least 7% at least 3 months apart during metformin treatment without add-on therapy. Those not experiencing clinical inertia included patients with HbA1c measurements of at least 7% at least 3 months apart who were prescribed add-on antidiabetes therapy. Researchers used logistic regression models to estimate the association between clinical inertia and demographic and clinical characteristics.
Within the cohort, 36% (n = 552) of patients experienced clinical inertia, according to the researchers. The most common comorbidities among those with clinical inertia included hypertension (68.1%), dyslipidemia (53.2%), and overweight or obesity (40.2%). Patients with clinical inertia were more likely to be Asian vs. those without clinical inertia (7.4% vs. 3.1%; P < .001).
The researchers found that Asian race was associated with an increased likelihood of clinical inertia (OR = 2.43; 95% CI, 1.48-3.96), whereas congestive heart failure was associated with a decreased likelihood for clinical inertia (OR = 0.58; 95% CI, 0.32-0.98). Researchers observed weaker associations between clinical inertia and chronic kidney disease as well as cardiovascular or cerebrovascular disease, but these were “directionally similar” to congestive heart failure, according to researchers.
“While it is well-known that racial and ethnic minorities are susceptible to increased risk [for] inadequate glycemic control and diabetes-related outcomes, little has been reported about Asian populations in the United States, and our results represent the first association of Asian race with clinical inertia to our knowledge,” the researchers wrote. “While more research is warranted, this result raises several potential explanatory hypotheses, including language barriers, diet, disease beliefs and differing disease physiology.”
The researchers noted that the 2011-2014 National Health and Nutrition Examination Survey suggested that non-Hispanic Asians were significantly more likely to be unaware of their diabetes than non-Hispanic whites, raising the hypothesis that diabetes awareness or disease understanding may underlie the observation.
“In addition to the specific results about clinical inertia, this study provides a template for a broader variety of studies into the real-world management of [type 2 diabetes],” the researchers wrote. “Additional insights may also be identified by more detailed mining of the narrative text of physician notes around treatment of follow-up decisions.” – by Regina Schaffer
Disclosures: Kartoun and three other authors report funding from Merck for this study. Four of the authors report employment with Merck Sharp & Dohme Corp.
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