Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: A retrospective cohort study
Background Clinical inertia is a failure to intensify treatment according to evidence‐based guidelines, and can have both short‐ and long‐term adverse effects for type 2 diabetes (T2D). The aim of the present study was to demonstrate the effects of clinical inertia on glycemic control and diabetes‐r...
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| description | Background
Clinical inertia is a failure to intensify treatment according to evidence‐based guidelines, and can have both short‐ and long‐term adverse effects for type 2 diabetes (T2D). The aim of the present study was to demonstrate the effects of clinical inertia on glycemic control and diabetes‐related complications.
Methods
A retrospective cohort study was conducted at a university‐based hospital in Thailand. Medical records were evaluated retrospectively from January 2010 to December 2014. Patients were classified into two groups: clinical inertia and non‐inertia. Clinical inertia was defined as failure to initiate insulin within 3 months in patients with HbA1c ≥9 % who were already taking two oral antidiabetic agents.
Results
From 1206 records, 98 patients with mean HbA1c of 10.3 % were identified and enrolled in the study. The median follow‐up time of these patients was 29.5 months and 68.4 % were classified into the clinical inertia group. The mean (± SD) HbA1c decrement in the clinical inertia and non‐inertia groups was 0.82 ± 1.50 % and 3.02 ± 1.80 %, respectively, at 6 months (P |
| doi_str_mv | 10.1111/1753-0407.12410 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_24P</sourceid><recordid>TN_cdi_proquest_miscellaneous_1826675064</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1826675064</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3690-2dfb93bf9f904ebd21db89a203949aed01e2dfa79d336e946be23d5b24256ed43</originalsourceid><addsrcrecordid>eNo9kU1PwzAMhiMEYmNw5oZy5LKRjzZduI3xrUlc4ByljbsFdU1JUqb-e9oxiOTYsh9b8muELimZ0f7d0CzlU5KQbEZZQskRGv9njv9iLvkInYXwSYjIhOCnaMQyIgcbo7isbG0LXWFbg49W40K3wdZrXMMOO48b79YeQrCuxq7Exuocoi2w7__aNTpuur4Vx64BzA5lCLd4MRDehQaKaL8BF27jfMQhtqY7RyelrgJcHPwEfTw-vC-fp6u3p5flYjUtuJBkykyZS56XspQkgdwwavK51KzfKJEaDKHQIzqThnMBMhE5MG7SnCUsFWASPkHXv3P7Jb5aCFFtbSigqnQNrg2KzpkQWUrEgF4d0DbfglGNt1vtO_WnVA-kv8DOVtD91ylRwyHUILUaZFf7Q6jX-7t9wH8Axnd7mg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1826675064</pqid></control><display><type>article</type><title>Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: A retrospective cohort study</title><source>Wiley Online Library Open Access</source><creator>Osataphan, Soravis ; Chalermchai, Thep ; Ngaosuwan, Kanchana</creator><creatorcontrib>Osataphan, Soravis ; Chalermchai, Thep ; Ngaosuwan, Kanchana</creatorcontrib><description>Background
Clinical inertia is a failure to intensify treatment according to evidence‐based guidelines, and can have both short‐ and long‐term adverse effects for type 2 diabetes (T2D). The aim of the present study was to demonstrate the effects of clinical inertia on glycemic control and diabetes‐related complications.
Methods
A retrospective cohort study was conducted at a university‐based hospital in Thailand. Medical records were evaluated retrospectively from January 2010 to December 2014. Patients were classified into two groups: clinical inertia and non‐inertia. Clinical inertia was defined as failure to initiate insulin within 3 months in patients with HbA1c ≥9 % who were already taking two oral antidiabetic agents.
Results
From 1206 records, 98 patients with mean HbA1c of 10.3 % were identified and enrolled in the study. The median follow‐up time of these patients was 29.5 months and 68.4 % were classified into the clinical inertia group. The mean (± SD) HbA1c decrement in the clinical inertia and non‐inertia groups was 0.82 ± 1.50 % and 3.02 ± 1.80 %, respectively, at 6 months (P < 0.001) and 1.46 ± 1.85 % and 3.04 ± 1.76 %, respectively, at the end of study (P < 0.001). Clinical inertia was associated with a significantly shorter median time to progression of diabetic retinopathy (DR); log rank test, P = 0.02 and a higher incidence of DR progression (10 vs 2.2 cases per 1000 person‐months; P = 0.003). The adjusted incidence rate ratio for DR progression in the clinical inertia group was 4.92 (95 % confidence interval 1.11–21.77; P = 0.036). Being treated by general practitioners was the strongest risk factor associated with clinical inertia.
Conclusions
Clinical inertia can cause persistently poor glycemic control and speed up the progression of DR in T2D.
背景: 临床惰性是指不能根据循证指南成功地对患者进行强化治疗,它可能对2型糖尿病患者具有短期和长期不良的影响。当前这项研究的目的是为了证实临床惰性对血糖控制情况以及糖尿病相关并发症的影响。
方法: 这是一项在泰国某大学医院中进行的回顾性队列研究。对2010年1月至2014年12月之间的医疗记录进行了回顾性评估。患者被分类为两组:临床惰性组与非惰性组。临床惰性被定义为已经使用两种口服降糖药进行治疗但HbA1c仍 ≥ 9%的患者不能在3个月之内成功启用胰岛素治疗。
结果: 从1206份记录中,鉴别出了98名平均HbA1c为10.3%的患者并且将他们纳入了这项研究。对这些患者的中位数随访时间为29.5月,并且68.4%的患者被分类为临床惰性组。在临床惰性组与非惰性组中平均(± SD)HbA1c的降幅在第6个月时分别为0.82 ± 1.50%与3.02 ± 1.80%(P < 0.001),在研究结束时分别为1.46 ± 1.85%与3.04 ± 1.76%(P < 0.001)。临床惰性与进展为糖尿病视网膜病变的中位数时间更短显著相关;使用对数秩检验发现P = 0.02并且糖尿病视网膜病变进展的发生率更高(分别为10与2.2例/1000名患者‐月;P = 0.003)。在临床惰性组中校正过的糖尿病视网膜病变进展发生率比值为4.92(95%可信区间为1.11‐21.77;P = 0.036)。与临床惰性最为相关的危险因素是接受全科医生治疗。
结论: 临床惰性可导致2型糖尿病患者的血糖持续控制不佳并且加速DR的进展。
Highlights
Transforming the clinical trials into the real‐life practice, clinical inertia speeds up the progression of diabetic retinopathy in type 2 diabetes.
General practitioners remain the major factor for clinical inertia in type 2 diabetes.
Kaplan–Meier curves for the occurrence of new or progressive diabetic retinopathy between the clinical inertia and non‐inertia groups.</description><identifier>ISSN: 1753-0393</identifier><identifier>EISSN: 1753-0407</identifier><identifier>DOI: 10.1111/1753-0407.12410</identifier><identifier>PMID: 27092709</identifier><language>eng</language><publisher>Australia</publisher><subject>Adult ; Aged ; Aged, 80 and over ; delayed insulin initiation ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetic Retinopathy - diagnosis ; Diabetic Retinopathy - etiology ; Disease Progression ; Female ; Glycated Hemoglobin A - metabolism ; Hospitals, University ; Humans ; Hypoglycemic Agents - therapeutic use ; Insulin - therapeutic use ; Logistic Models ; Male ; microvascular complication ; Middle Aged ; poor glycemic control ; Retrospective Studies ; Risk Factors ; Thailand ; Time Factors ; 推迟启动胰岛素治疗,微血管并发症,血糖控制不佳,泰国</subject><ispartof>Journal of diabetes, 2017-03, Vol.9 (3), p.267-274</ispartof><rights>2016 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd</rights><rights>2016 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3690-2dfb93bf9f904ebd21db89a203949aed01e2dfa79d336e946be23d5b24256ed43</citedby><orcidid>0000-0003-4392-269X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2F1753-0407.12410$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2F1753-0407.12410$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,11562,27924,27925,45574,45575,46052,46476</link.rule.ids><linktorsrc>$$Uhttps://onlinelibrary.wiley.com/doi/abs/10.1111%2F1753-0407.12410$$EView_record_in_Wiley-Blackwell$$FView_record_in_$$GWiley-Blackwell</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27092709$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Osataphan, Soravis</creatorcontrib><creatorcontrib>Chalermchai, Thep</creatorcontrib><creatorcontrib>Ngaosuwan, Kanchana</creatorcontrib><title>Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: A retrospective cohort study</title><title>Journal of diabetes</title><addtitle>J Diabetes</addtitle><description>Background
Clinical inertia is a failure to intensify treatment according to evidence‐based guidelines, and can have both short‐ and long‐term adverse effects for type 2 diabetes (T2D). The aim of the present study was to demonstrate the effects of clinical inertia on glycemic control and diabetes‐related complications.
Methods
A retrospective cohort study was conducted at a university‐based hospital in Thailand. Medical records were evaluated retrospectively from January 2010 to December 2014. Patients were classified into two groups: clinical inertia and non‐inertia. Clinical inertia was defined as failure to initiate insulin within 3 months in patients with HbA1c ≥9 % who were already taking two oral antidiabetic agents.
Results
From 1206 records, 98 patients with mean HbA1c of 10.3 % were identified and enrolled in the study. The median follow‐up time of these patients was 29.5 months and 68.4 % were classified into the clinical inertia group. The mean (± SD) HbA1c decrement in the clinical inertia and non‐inertia groups was 0.82 ± 1.50 % and 3.02 ± 1.80 %, respectively, at 6 months (P < 0.001) and 1.46 ± 1.85 % and 3.04 ± 1.76 %, respectively, at the end of study (P < 0.001). Clinical inertia was associated with a significantly shorter median time to progression of diabetic retinopathy (DR); log rank test, P = 0.02 and a higher incidence of DR progression (10 vs 2.2 cases per 1000 person‐months; P = 0.003). The adjusted incidence rate ratio for DR progression in the clinical inertia group was 4.92 (95 % confidence interval 1.11–21.77; P = 0.036). Being treated by general practitioners was the strongest risk factor associated with clinical inertia.
Conclusions
Clinical inertia can cause persistently poor glycemic control and speed up the progression of DR in T2D.
背景: 临床惰性是指不能根据循证指南成功地对患者进行强化治疗,它可能对2型糖尿病患者具有短期和长期不良的影响。当前这项研究的目的是为了证实临床惰性对血糖控制情况以及糖尿病相关并发症的影响。
方法: 这是一项在泰国某大学医院中进行的回顾性队列研究。对2010年1月至2014年12月之间的医疗记录进行了回顾性评估。患者被分类为两组:临床惰性组与非惰性组。临床惰性被定义为已经使用两种口服降糖药进行治疗但HbA1c仍 ≥ 9%的患者不能在3个月之内成功启用胰岛素治疗。
结果: 从1206份记录中,鉴别出了98名平均HbA1c为10.3%的患者并且将他们纳入了这项研究。对这些患者的中位数随访时间为29.5月,并且68.4%的患者被分类为临床惰性组。在临床惰性组与非惰性组中平均(± SD)HbA1c的降幅在第6个月时分别为0.82 ± 1.50%与3.02 ± 1.80%(P < 0.001),在研究结束时分别为1.46 ± 1.85%与3.04 ± 1.76%(P < 0.001)。临床惰性与进展为糖尿病视网膜病变的中位数时间更短显著相关;使用对数秩检验发现P = 0.02并且糖尿病视网膜病变进展的发生率更高(分别为10与2.2例/1000名患者‐月;P = 0.003)。在临床惰性组中校正过的糖尿病视网膜病变进展发生率比值为4.92(95%可信区间为1.11‐21.77;P = 0.036)。与临床惰性最为相关的危险因素是接受全科医生治疗。
结论: 临床惰性可导致2型糖尿病患者的血糖持续控制不佳并且加速DR的进展。
Highlights
Transforming the clinical trials into the real‐life practice, clinical inertia speeds up the progression of diabetic retinopathy in type 2 diabetes.
General practitioners remain the major factor for clinical inertia in type 2 diabetes.
Kaplan–Meier curves for the occurrence of new or progressive diabetic retinopathy between the clinical inertia and non‐inertia groups.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>delayed insulin initiation</subject><subject>Diabetes Mellitus, Type 2 - blood</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Diabetic Retinopathy - diagnosis</subject><subject>Diabetic Retinopathy - etiology</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Glycated Hemoglobin A - metabolism</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Insulin - therapeutic use</subject><subject>Logistic Models</subject><subject>Male</subject><subject>microvascular complication</subject><subject>Middle Aged</subject><subject>poor glycemic control</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Thailand</subject><subject>Time Factors</subject><subject>推迟启动胰岛素治疗,微血管并发症,血糖控制不佳,泰国</subject><issn>1753-0393</issn><issn>1753-0407</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kU1PwzAMhiMEYmNw5oZy5LKRjzZduI3xrUlc4ByljbsFdU1JUqb-e9oxiOTYsh9b8muELimZ0f7d0CzlU5KQbEZZQskRGv9njv9iLvkInYXwSYjIhOCnaMQyIgcbo7isbG0LXWFbg49W40K3wdZrXMMOO48b79YeQrCuxq7Exuocoi2w7__aNTpuur4Vx64BzA5lCLd4MRDehQaKaL8BF27jfMQhtqY7RyelrgJcHPwEfTw-vC-fp6u3p5flYjUtuJBkykyZS56XspQkgdwwavK51KzfKJEaDKHQIzqThnMBMhE5MG7SnCUsFWASPkHXv3P7Jb5aCFFtbSigqnQNrg2KzpkQWUrEgF4d0DbfglGNt1vtO_WnVA-kv8DOVtD91ylRwyHUILUaZFf7Q6jX-7t9wH8Axnd7mg</recordid><startdate>201703</startdate><enddate>201703</enddate><creator>Osataphan, Soravis</creator><creator>Chalermchai, Thep</creator><creator>Ngaosuwan, Kanchana</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4392-269X</orcidid></search><sort><creationdate>201703</creationdate><title>Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: A retrospective cohort study</title><author>Osataphan, Soravis ; Chalermchai, Thep ; Ngaosuwan, Kanchana</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3690-2dfb93bf9f904ebd21db89a203949aed01e2dfa79d336e946be23d5b24256ed43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>delayed insulin initiation</topic><topic>Diabetes Mellitus, Type 2 - blood</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - drug therapy</topic><topic>Diabetic Retinopathy - diagnosis</topic><topic>Diabetic Retinopathy - etiology</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Glycated Hemoglobin A - metabolism</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Hypoglycemic Agents - therapeutic use</topic><topic>Insulin - therapeutic use</topic><topic>Logistic Models</topic><topic>Male</topic><topic>microvascular complication</topic><topic>Middle Aged</topic><topic>poor glycemic control</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Thailand</topic><topic>Time Factors</topic><topic>推迟启动胰岛素治疗,微血管并发症,血糖控制不佳,泰国</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Osataphan, Soravis</creatorcontrib><creatorcontrib>Chalermchai, Thep</creatorcontrib><creatorcontrib>Ngaosuwan, Kanchana</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of diabetes</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Osataphan, Soravis</au><au>Chalermchai, Thep</au><au>Ngaosuwan, Kanchana</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: A retrospective cohort study</atitle><jtitle>Journal of diabetes</jtitle><addtitle>J Diabetes</addtitle><date>2017-03</date><risdate>2017</risdate><volume>9</volume><issue>3</issue><spage>267</spage><epage>274</epage><pages>267-274</pages><issn>1753-0393</issn><eissn>1753-0407</eissn><abstract>Background
Clinical inertia is a failure to intensify treatment according to evidence‐based guidelines, and can have both short‐ and long‐term adverse effects for type 2 diabetes (T2D). The aim of the present study was to demonstrate the effects of clinical inertia on glycemic control and diabetes‐related complications.
Methods
A retrospective cohort study was conducted at a university‐based hospital in Thailand. Medical records were evaluated retrospectively from January 2010 to December 2014. Patients were classified into two groups: clinical inertia and non‐inertia. Clinical inertia was defined as failure to initiate insulin within 3 months in patients with HbA1c ≥9 % who were already taking two oral antidiabetic agents.
Results
From 1206 records, 98 patients with mean HbA1c of 10.3 % were identified and enrolled in the study. The median follow‐up time of these patients was 29.5 months and 68.4 % were classified into the clinical inertia group. The mean (± SD) HbA1c decrement in the clinical inertia and non‐inertia groups was 0.82 ± 1.50 % and 3.02 ± 1.80 %, respectively, at 6 months (P < 0.001) and 1.46 ± 1.85 % and 3.04 ± 1.76 %, respectively, at the end of study (P < 0.001). Clinical inertia was associated with a significantly shorter median time to progression of diabetic retinopathy (DR); log rank test, P = 0.02 and a higher incidence of DR progression (10 vs 2.2 cases per 1000 person‐months; P = 0.003). The adjusted incidence rate ratio for DR progression in the clinical inertia group was 4.92 (95 % confidence interval 1.11–21.77; P = 0.036). Being treated by general practitioners was the strongest risk factor associated with clinical inertia.
Conclusions
Clinical inertia can cause persistently poor glycemic control and speed up the progression of DR in T2D.
背景: 临床惰性是指不能根据循证指南成功地对患者进行强化治疗,它可能对2型糖尿病患者具有短期和长期不良的影响。当前这项研究的目的是为了证实临床惰性对血糖控制情况以及糖尿病相关并发症的影响。
方法: 这是一项在泰国某大学医院中进行的回顾性队列研究。对2010年1月至2014年12月之间的医疗记录进行了回顾性评估。患者被分类为两组:临床惰性组与非惰性组。临床惰性被定义为已经使用两种口服降糖药进行治疗但HbA1c仍 ≥ 9%的患者不能在3个月之内成功启用胰岛素治疗。
结果: 从1206份记录中,鉴别出了98名平均HbA1c为10.3%的患者并且将他们纳入了这项研究。对这些患者的中位数随访时间为29.5月,并且68.4%的患者被分类为临床惰性组。在临床惰性组与非惰性组中平均(± SD)HbA1c的降幅在第6个月时分别为0.82 ± 1.50%与3.02 ± 1.80%(P < 0.001),在研究结束时分别为1.46 ± 1.85%与3.04 ± 1.76%(P < 0.001)。临床惰性与进展为糖尿病视网膜病变的中位数时间更短显著相关;使用对数秩检验发现P = 0.02并且糖尿病视网膜病变进展的发生率更高(分别为10与2.2例/1000名患者‐月;P = 0.003)。在临床惰性组中校正过的糖尿病视网膜病变进展发生率比值为4.92(95%可信区间为1.11‐21.77;P = 0.036)。与临床惰性最为相关的危险因素是接受全科医生治疗。
结论: 临床惰性可导致2型糖尿病患者的血糖持续控制不佳并且加速DR的进展。
Highlights
Transforming the clinical trials into the real‐life practice, clinical inertia speeds up the progression of diabetic retinopathy in type 2 diabetes.
General practitioners remain the major factor for clinical inertia in type 2 diabetes.
Kaplan–Meier curves for the occurrence of new or progressive diabetic retinopathy between the clinical inertia and non‐inertia groups.</abstract><cop>Australia</cop><pmid>27092709</pmid><doi>10.1111/1753-0407.12410</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0003-4392-269X</orcidid></addata></record> |
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| ispartof | Journal of diabetes, 2017-03, Vol.9 (3), p.267-274 |
| issn | 1753-0393 1753-0407 |
| language | eng |
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| source | Wiley Online Library Open Access |
| subjects | Adult Aged Aged, 80 and over delayed insulin initiation Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - drug therapy Diabetic Retinopathy - diagnosis Diabetic Retinopathy - etiology Disease Progression Female Glycated Hemoglobin A - metabolism Hospitals, University Humans Hypoglycemic Agents - therapeutic use Insulin - therapeutic use Logistic Models Male microvascular complication Middle Aged poor glycemic control Retrospective Studies Risk Factors Thailand Time Factors 推迟启动胰岛素治疗,微血管并发症,血糖控制不佳,泰国 |
| title | Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: A retrospective cohort study |
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