Several studies have previously reported “clinical inertia” in the sequential treatment of T2D patients. The objective of the study was to quantify the distance from HbA1c target at the time of treatment intensification among patients failing dual therapy of metformin and another oral antihyperglycemic agent (OAHA). This retrospective study was conducted using GE Centricity Electronic Medical Record database (2015 data). Patients included those with diagnosed T2D on metformin dual therapy with at least 12 months of continuous enrollment prior to index date (initiation of dual therapy), documented HbA1c ≥7% and intensifying therapy within two years following index date. Treatment intensification was defined as either addition of another OAHA or initiation of insulin/glucagon-like peptide-1 receptor agonists. Distance from glycemic target was calculated as the median difference of HbA1c from target of 7% at the time of therapy intensification. 864 patients met the study criteria; mean age of 57.5 years, 48% were female, 26.3% had microvascular and 18.4% had macrovascular complications. Median difference from HbA1c target of 7% was 1.4%, with 29% (n=253) of patients between 1 to 2%, and 36% (n=315) greater than 2% distance from HbA1c target. When we excluded those for whom higher HbA1c target may be more appropriate (those ≥65 years, with micro- or macrovascular complications or with history of hypoglycemia), the median difference was 1.6%. This study suggests that majority of metformin dual therapy patients (65.7%) were at least 1% away from target of 7% at the time of intensification of therapy. Future studies should explore reasons behind this lack of earlier intensification and factors associated with clinical inertia.


G. Fernandes: None. B. Sawhney: Consultant; Self; Merck & Co., Inc. H. Hannachi: Employee; Self; Merck & Co., Inc. T. Wang: Employee; Spouse/Partner; Johnson & Johnson. Employee; Self; Merck & Co., Inc. A. McNeill: Employee; Self; Merck & Co., Inc. K. Iglay: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. S. Rajpathak: None.

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