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      Addressing Therapeutic Inertia in 2020 and Beyond: A 3-Year Initiative of the American Diabetes Association

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          Abstract

          Research has shown that getting to glycemic targets early on leads to better outcomes in people with type 2 diabetes; yet, there has been no improvement in the attainment of A1C targets in the past decade. One reason is therapeutic inertia: the lack of timely adjustment to the treatment regimen when a person’s therapeutic targets are not met. This article describes the scope and priorities of the American Diabetes Association’s 3-year Overcoming Therapeutic Inertia Initiative. Its planned activities include publishing a systematic review and meta-analysis of approaches to reducing therapeutic inertia, developing a registry of effective strategies, launching clinician awareness and education campaigns, leveraging electronic health record and clinical decision-support tools, influencing payer policies, and potentially executing pragmatic research to test promising interventions.

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          Most cited references49

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          Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)

          (1998)
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            10-year follow-up of intensive glucose control in type 2 diabetes.

            During the United Kingdom Prospective Diabetes Study (UKPDS), patients with type 2 diabetes mellitus who received intensive glucose therapy had a lower risk of microvascular complications than did those receiving conventional dietary therapy. We conducted post-trial monitoring to determine whether this improved glucose control persisted and whether such therapy had a long-term effect on macrovascular outcomes. Of 5102 patients with newly diagnosed type 2 diabetes, 4209 were randomly assigned to receive either conventional therapy (dietary restriction) or intensive therapy (either sulfonylurea or insulin or, in overweight patients, metformin) for glucose control. In post-trial monitoring, 3277 patients were asked to attend annual UKPDS clinics for 5 years, but no attempts were made to maintain their previously assigned therapies. Annual questionnaires were used to follow patients who were unable to attend the clinics, and all patients in years 6 to 10 were assessed through questionnaires. We examined seven prespecified aggregate clinical outcomes from the UKPDS on an intention-to-treat basis, according to previous randomization categories. Between-group differences in glycated hemoglobin levels were lost after the first year. In the sulfonylurea-insulin group, relative reductions in risk persisted at 10 years for any diabetes-related end point (9%, P=0.04) and microvascular disease (24%, P=0.001), and risk reductions for myocardial infarction (15%, P=0.01) and death from any cause (13%, P=0.007) emerged over time, as more events occurred. In the metformin group, significant risk reductions persisted for any diabetes-related end point (21%, P=0.01), myocardial infarction (33%, P=0.005), and death from any cause (27%, P=0.002). Despite an early loss of glycemic differences, a continued reduction in microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post-trial follow-up. A continued benefit after metformin therapy was evident among overweight patients. (UKPDS 80; Current Controlled Trials number, ISRCTN75451837.) 2008 Massachusetts Medical Society
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              Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

              The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the prior position statements, published in 2012 and 2015, on the management of type 2 diabetes in adults. A systematic evaluation of the literature since 2014 informed new recommendations. These include additional focus on lifestyle management and diabetes self-management education and support. For those with obesity, efforts targeting weight loss, including lifestyle, medication, and surgical interventions, are recommended. With regards to medication management, for patients with clinical cardiovascular disease, a sodium–glucose cotransporter 2 (SGLT2) inhibitor or a glucagon-like peptide 1 (GLP-1) receptor agonist with proven cardiovascular benefit is recommended. For patients with chronic kidney disease or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with proven benefit is recommended. GLP-1 receptor agonists are generally recommended as the first injectable medication.
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                Author and article information

                Journal
                Clin Diabetes
                Clin Diabetes
                diaclin
                Clinical Diabetes
                Clinical Diabetes : A Publication of the American Diabetes Association
                American Diabetes Association
                0891-8929
                1945-4953
                October 2020
                : 38
                : 4
                : 371-381
                Affiliations
                [1 ]American Diabetes Association, Arlington, VA
                [2 ]Kendall Editorial, Richmond, VA
                [3 ]Diabetes educator consultant, San Diego, CA
                [4 ]American Medical Group Association, Alexandria, VA
                [5 ]Novo Nordisk, Plainsboro, NJ
                [6 ]AstraZeneca, Wilmington, DE
                [7 ]Tabula Rasa HealthCare, Tucson, AZ
                [8 ]Diabetes Nation, Bend, OR
                [9 ]Capital Diabetes & Endocrine Associates, Silver Spring, MD
                [10 ]Merck and Co., Kenilworth, NJ
                [11 ]UT Southwestern Medical Center, Parkland Health & Hospital System, Dallas, TX
                [12 ]Diabetes Research Centre, University of Leicester, Leicester, UK
                Author notes
                Corresponding author: Paul Scribner, PScribner@ 123456diabetes.org
                [*]

                Joint senior author.

                Author information
                http://orcid.org/0000-0001-8733-8802
                http://orcid.org/0000-0002-6052-2949
                http://orcid.org/0000-0003-4539-2725
                http://orcid.org/0000-0003-2343-7099
                Article
                CD200053
                10.2337/cd20-0053
                7566926
                33132507
                8a0a5314-ec73-4a3e-8121-8b241fef5a8d
                © 2020 by the American Diabetes Association

                Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://www.diabetesjournals.org/content/license.

                History
                Page count
                Pages: 11
                Categories
                Perspectives in Clinical Diabetes

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