ArticlePloS one2020
Clinical inertia in type 2 diabetes management in a middle-income country: A retrospective cohort study.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- Hypertension in Adults With Diabetes in Southeast Asia: A Systematic Review.Journal of clinical hypertension (Greenwich, Conn.) · 2025Pooled it
- Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review.Medicina (Kaunas, Lithuania) · 2023Pooled it
- Association of collaborative care intervention features with depression and metabolic outcomes in the INDEPENDENT study: A mixed methods study.Primary care diabetes · 2024Trial
- Effectiveness of a diabetes program based on digital health on capacity building and quality of care in type 2 diabetes: a pragmatic quasi-experimental study.BMC health services research · 2023Trial
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- Characteristics of type 2 diabetes patients with overt cardiovascular diseases in Malaysia: the real-world evidence from the National Diabetes Registry.BMC research notes · 2025Article
- Factors associated with annual eye examinations among known diabetics in Malaysia: a cross-sectional study from the National Health and Morbidity Survey 2023.International journal of ophthalmology · 2025Article
- Clinical inertia and treatment intensification among patients with type ii diabetes mellitus at Debre Tabor comprehensive specialized hospital, Ethiopia: an institutional-based cross-sectional study.Frontiers in endocrinology · 2025Article
- Treatment intensification and therapeutic inertia of antihypertensive therapy among patients with type 2 diabetes and hypertension with uncontrolled blood pressure.Scientific reports · 2024Article
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- HbA1c control in type 2 diabetes mellitus patients with coronary artery disease: a retrospective study in a tertiary hospital in South Africa.Frontiers in clinical diabetes and healthcare · 2023Article
- Is therapeutic inertia present in hyperglycaemia, hypertension and hypercholesterolaemia management among adults with type 2 diabetes in three health clinics in Malaysia? a retrospective cohort study.BMC family practice · 2021Observational
- Predictors of glycosylated haemoglobin A1C trend among type 2 diabetes patients in a multi-ethnic country.Scientific reports · 2021Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundClinical inertia can lead to poor glycemic control among type 2 diabetes patients. However, there is paucity of information on clinical inertia in low- and middle-income countries including Malaysia. This study aimed to determine the time to treatment intensification among T2D patients with HbA1c of ≥7% (≥53 mmol/mol) in Malaysian public health clinics. The proportion of patients with treatment intensification and its associated factors were also determined. MATERIAL AND
methodsThis was a five-year retrospective open cohort study using secondary data from the National Diabetes Registry. The study setting was all public health clinics (n = 47) in the state of Negeri Sembilan, Malaysia. Time to treatment intensification was defined as the number of years from the index year until the addition of another oral antidiabetic drug or initiation of insulin. Life table survival analysis based on best-worst case scenarios was used to determine the time to treatment intensification. Discrete-time proportional hazards model was fitted for the factors associated with treatment intensification.
resultsThe mean follow-up duration was 2.6 (SD 1.1) years. Of 7,646 patients, the median time to treatment intensification was 1.29 years (15.5 months), 1.58 years (19.0 months) and 2.32 years (27.8 months) under the best-, average- and worst-case scenarios respectively. The proportion of patients with treatment intensification was 45.4% (95% CI: 44.2-46.5), of which 34.6% occurred only after one year. Younger adults, overweight, obesity, use of antiplatelet medications and poorer HbA1c were positively associated with treatment intensification. Patients treated with more oral antidiabetics were less likely to have treatment intensification.
conclusionClinical inertia is present in the management of T2D patients in Malaysian public health clinics. We recommend further studies in lower- and middle-income countries to explore its causes so that targeted strategies can be developed to address this issue.
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