Primary Care Diabetes Europe Issues Call to Action Against Clinical Inertia in the Treatment of Type-2 Diabetes

- Research identifies lack of primary care physician adherence to treatment guidelines among the challenges to optimal care for patients with type-2 diabetes    Primary Care Diabetes Europe (PCDE) today issued a call to action challenging primary care physicians and other healthcare providers to escalate treatment of type-2 diabetes (T2D). This includes encouraging the use of innovative and second- or third-line medicines earlier in disease management of T2D, optimising the potential to impact the disease. PCDE researchers also echo mounting scientific evidence that suboptimal management of T2D can increase the risk of common interrelated cardiovascular (CV) and renal comorbidities, further undermining patient care. Dr. Frances Xavier Cos, Chairman of PCDE, said: "Globally, one in 11 adults has diabetes[i] and delays in treatment can lead to an increase in comorbidities[ii] including heart failure, an early and frequent complication of diabetes that is associated with hospitalisations resulting in a considerable societal and economic burden.[iii] The early use of innovative treatments in type-2 diabetes is critical in helping people successfully manage their diabetes and the interrelated CV and renal risks, ultimately helping improve outcomes.[iv] Professional guidelines increasingly identify how and when these treatments can optimally be used, and primary care doctors in particular should be aware of the value of timely escalation of treatment as they are the front lines of care for patients with type-2 diabetes." The call to action is supported by recent research conducted by PCDE to identify causes of widespread clinical inertia among physicians, or the failure to establish appropriate targets and escalate treatment to achieve each patient's individual treatment goals. High-level results from this research find a lack of adherence to clinical guidelines on appropriate use of these therapies, as well as other causes, including lack of familiarity with treatment options, availability and cost as key drivers of clinical inertia.* Full findings from the research, which was commissioned by AstraZeneca and conducted in partnership with PCDE, along with detailed PCDE recommendations, will be published in 2019 in Primary Care Diabetes. These research findings and the PCDE call to action are especially timely following the recent American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consensus statement that addresses clinical inertia. The statement supports a more patient-centric and integrated approach to the management of diabetes and related CV and renal conditions, including lifestyle interventions and earlier use of medicines with proven CV and renal benefits. The ADA/EASD statement also supports treatment guidelines that are informed by the latest research on early use of these multi-functional medicines. Dr. Danilo Verge, Vice President, Cardiovascular, Renal & Metabolism, Global Medical Affairs, AstraZeneca, commented: "As a member of the Early Action in Diabetes coalition, AstraZeneca supports Primary Care Diabetes Europe as it contributes to our growing understanding of the importance of early treatment of type-2 diabetes, cardiovascular and renal disease in an integrated and proactive way. We are also working with researchers on an economic impact study to understand the full value to patients and our health systems when these diseases are managed together. The need is clear on many levels and we stand with Primary Care Diabetes Europe in urging a united, patient-centric response." To learn more about the Primary Care Diabetes Europe call to action and type-2 diabetes, visit https://www.pcdeurope.org/news/. *PCDE conducted two separate quantitative and qualitative studies involving perceptions and treatment practices among primary care physicians in the United Kingdom, Spain, Italy, Germany, Poland, Belgium, Denmark, Netherlands, Portugal, Romania, Spain, Sweden and Switzerland. Findings indicate that, while first line treatment is generally administered in adherence with guidelines, many primary care physicians see those guidelines as less prescriptive or reliable than personal clinical experience and the opinion of colleagues when it comes to the use of other medicines. NOTES TO EDITORS   About Diabetes    In 2017, 4 million patients died globally as a result of diabetes and its complications.[v] Nearly 650 million people will have diabetes by 2040, and the cost of treating the disease just in adults aged 20-79 years will be $802 billion.[vi] Delays in treatment can lead to suboptimal glycaemic control, poor management of the disease and an increase in comorbidities.[vii] Poorly controlled diabetes can increase the risk of cardiovascular disease, blindness, kidney failure, amputations and premature death.[viii] About Primary Care Diabetes Europe (PCDE)   Primary Care Diabetes Europe (PCDE) exists to provide a focal point for primary care clinicians and their patients. Its purpose is to promote high standards of care for people living with diabetes throughout Europe. Emphasis is placed on incorporating evidence based medicine into daily practice as well as promoting diabetes education and research in primary care. Through successful activities and a leadership position in the field, PCDE has an interface role between primary and secondary diabetes care organizations regarding research, education, clinical practice and health care governance aiming for a better quality of diabetes care in the community. About Early Action in Diabetes   Early Action in Diabetes (EAiD) is an international coalition of clinicians, policymakers and other diabetes experts from more than 35 countries who are committed to radically transforming the world's approach to type-2 diabetes and its complications. This multi-year initiative works to translate evidence into practical policies for strengthening prevention, early detection, early control and early access to the right interventions with the goal of improving patient outcomes and the impact of these diseases on healthcare systems and national economies. Contact  Harry Wade, Ruder Finn, wadeh@ruderfinn.com, +1-917-4829057 i AstraZeneca (2017) The Berlin Declaration - A collective ambition for policy change to drive early action in type 2 diabetes. ii Khunti, K. et al. (2018) Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: A systematic review, Diabetes, Obesity and Metabolism, 20:427-437. iii International Diabetes Federation, IDF Diabetes Atlas, Eighth Edition Update, 2017; Shah AD, Langenberg C, Rapsomaniki E, et al. Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people. Lancet Diabetes Endocrinol. 2015;3:105-113; Faden, et al. The increasing detection of asymptomatic left ventricular dysfunction in patients with type 2 diabetes mellitus without overt cardiac disease: Data from the SHORTWAVE study. Diabetes Res Clin Pract. 2013;101(3):309-16; Low Wang, Cecilia C. et al. "Atherosclerotic Cardiovascular Disease and Heart Failure in Type 2 Diabetes - Mechanisms, Management, and Clinical Considerations." Circulation 133.24 (2016): 2459-2502. PMC. Web. 19 Sept. 2018; Heidenreich, Paul A. et al. "Forecasting the Impact of Heart Failure in the United States: A Policy Statement From the American Heart Association." Circulation. Heart failure 6.3 (2013): 606-619. PMC. Web. 19 Sept. 2018; Nichols GA, Brown JB: The impact of cardiovascular disease on medical care costs in subjects with and without type 2 diabetes. Diabetes Care 25:482-486, 2002; Nichols, et al. The incidence of congestive heart failure in type 2 diabetes. Diabetes Care, Volume 27, Number 8, Aug. 2004: http://care.diabetesjournals.org/content/27/8/1879 . iv Supporting earlier action in the treatment of Type 2 Diabetes - a call to action; source cited: International Diabetes Federation, IDF Diabetes Atlas, Seventh Edition, 2015. v International Diabetes Federation, IDF Diabetes Atlas, Eighth Edition, 2017. vi International Diabetes Federation, IDF Diabetes Atlas, Seventh Edition, 2015. vii Khunti, K. et al. (2018) Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: A systematic review, Diabetes, Obesity and Metabolism, 20:427-437. viii International Diabetes Federation and International Working Group on the Diabetic Foot, Diabetes. Available at: http://www.idf.org/webdata/docs/background_info_NA.pdf .