Background/Aims: Therapeutic inertia (TI) in glycaemic and blood pressure (BP) control and the association of TI with cardiovascular disease (CVD) in newly diagnosed type 2 diabetes (T2DM) patients have not been explored. The aims of this longitudinal cohort study were to evaluate the prevalence and extent of TI, and the association of TI with the risk of a composite of myocardial infarction (MI), heart failure (HF) and stroke.

Methods: A cohort of 1,145,807 patients newly diagnosed with T2DM from January 2000, aged ≤70 years, was selected from the Centricity EMR Database of USA. In patients with HbA1c and BP persistently above target for 2 years, time to first anti-diabetes / anti-hypertensive drug (ADD/AHD) and time to intensification with second therapy were evaluated. 

Results:  Patients had a mean age of 55 years, HbA1c 8.4%, SBP 132 mmHg, 60% had HbA1c ≥7.5%, and 28% had SBP ≥140 mmHg at diagnosis. Over 2 years, 76%/53% had HbA1c ≥ 7%/7.5% and 10% had SBP ≥ 140 mmHg consistently. Among patients with persistent HbA1c ≥7.5% over two years, 26% did not receive any ADD, 16%/58% received one/≥ 2 ADD, with mean time to such therapy 21/37 months. Among patients with SBP ≥ 140 mmHg, 18% did not receive any AHD, 4%/78% received one/≥ 2 AHD, with mean time to such therapy 17/33 months. In patients without a history of CVD, TI for glycaemia was associated with 30% (95% CI of HR: 1.13, 1.49) increased adjusted risk of a composite events.  

Conclusion: In a large population of T2DM patients age ≤70 years, a high prevalence of TI, including 1 in 8 with persistent HbA1c ≥ 7.5%, and no AHD use over two years, and an association of TI with increased CV risk were observed. Greater efforts are needed to understand, identify and appropriately manage therapeutic inertia.