Prevalence of Therapeutic Inertia in the Management of Overweight and Obesity in Patients With a Diagnosis of Type 2 Diabetes Who Are Followed up by Primary Care Physicians.

Abstract

Introduction: Information on therapeutic inertia (TI) in weight loss in people with type 2 diabetes (T2D) is limited.

Objective: To describe the prevalence of TI in the management of overweight/obesity in people with T2D undergoing primary care program (PCP) follow-up and weight changes according to the prescribed treatment.

Methods: A retrospective longitudinal study was conducted in patients with T2D with body mass index (BMI) ≥ 25 kg/m² followed by PCP. The following data were obtained from medical records at the first assessment, 6 and 12 months: anthropometric data, HbA1c, medications added according to their effect on weight, and specialist referrals (nutrition and metabolic and bariatric surgery).

Results: A total of 128 patients were included (age 65.5 ± 11.7 years, HbA1c 7.8 ± 1.7%, BMI 33.1 ± 5.7 kg/m²). The mean HbA1c at the end of follow-up was 7.4% ± 1.4%. Twenty-five percent achieved ≥ 5% weight loss after 12 months. The proportion of patients without weight-loss interventions increased from 59% in the first assessment to 86% and 89% after 6 and 12 months of follow-up. Patients who lost ≥ 5% of their weight were more likely to be referred to dietary counseling at program entry (37.5% vs. 23.4%) and at 6 months (18.8% vs. 6.4%) compared to patients who gained weight. In addition, the prescription of SGLT2 inhibitors/GLP1-receptor agonist was higher in this group at 6 months (49.3% vs. 10.7%).

Conclusions: Although there was a reduction in HbA1c, the TI for prescribing weight-loss interventions was high. This suggests the importance of including weight loss as a therapeutic goal alongside lowering HbA1c in primary care.