Abstract

CLINICAL INERTIA AMONGST PATIENTS WITH TYPE II DIABETES MELLITUS

Tasneem El Sheikh, Tarig Osman*, Nahid Osman, Zeinab Elrayah

Abstract

Background: There is an urgent need to overcome clinical inertia, as there is good evidence that effective management of diabetes can reduce long term costs, can benefit society and the economy, and can improve patients’ outcomes and quality of life. Objectives: The main objective was to study clinical inertia in the management of type 2 diabetes mellitus in selected diabetes centres at Khartoum state. Method: A cross-sectional study was performed; on 160 type 2 diabetic patients who were attending four selected diabetes centres in Khartoum state between November to December 2018. The Data were collected using questionnaire sheets then analyzed using statistical package for social science (SPSS) v 24.0 Result: Most patients (57.9%) had age ranged between 40-60y, 67.5% were female 32.5% had primary school education level, 78.8% were resident in Khartoum state, 59.5% were housewives, 13.8% employers, 6.1% teachers and 54% had low economic status, 39% had moderate, 30.5% had HTN, 8.6% CVD, 4.9% renal problems, 57.4% had family history of DM and 36.9% of HTN, 56.9% was fair in physical activity, 11.9% good, 51.9% had controlled diet. The average of HbA1c was 8.38, FBS was 175.75, and S Cr was 0.859, 41% were used insulin, and 59% were used oral antidiabetics. Of patients who were indicated for insulin and were not using it, there were 52% of patients did not use insulin because it was not prescribed by physicians, 22% phobia of injection. 41.3% were developed complication of neuropathy, 33.8% retinopathy, 70% had good medication adherence, 65% had regular follow up, 53.1% did not know target glycemic control. 27.70% of patients who were using insulin had reached the target glycemic control (HbA1C ≤ 7), and 53.70 % on non-insulin had not reached the target glycemic control. Conclusion: The study concluded that almost half of the patients with clinical inertia. More effort is required to improve knowledge and confidence of physicians. Glycemic control is affected by occupation, socioeconomic status, physical activity, diet and follow up regularity. Initiation of insulin is associated with poor glycemic control in patients with type II diabetes mellitus. These findings warrant additional studies examining the benefits of rapid titration to maximum doses and earlier initiation of insulin therapy. Also, further research is needed to understand the clinician, patient, and system barriers to therapy intensification.

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