The majority of British diabetics are being “let down” by their GPs because they are having to wait nearly four years for further much needed treatments.
Sufferers of type 2 diabetes have to control their blood glucose levels but when this fails they need insulin to keep levels stable.
But it is a progressive diseases and more intensive treatments are needed to keep the diabetes in check.
Yet only a third of those needing further medication were actually given it, the University of Leicester study found .
And “clinical inertia,” the failure to intensify treatment regimens when required, was to blame.
This means the average waiting time for increased treatment from the start of insulin is 3.7 years and those waiting longest were the elderly or those diagnosed for a long time.
Researchers warned delays could lead to complications as untreated diabetes can lead to blindness, kidney failure and limb amputations.
Diabetics are also five times more likely to have cardiovascular disease such as a stroke.
Type 2 diabetes is often associated with obesity and tends to be diagnosed in older people and numbers are rapidly increasing.
An estimated one in 16 people Britons or 3.9 million, has diabetes either diagnosed or undiagnosed – nine in ten with type 2.
It can be prevented from developing by making lifestyle changes such as eating a healthy, balanced diet, losing and maintaining a healthy weight, quitting smoking, cutting down on drinking and exercising.
As type 2 diabetes usually gets worse, diabetics may eventually need medication to keep blood glucose at normal levels.
Yet maintaining tight control of blood sugars in Type 2 diabetes can lead to significant reductions in related complications
Professor Kamlesh Khunti said: “Type 2 diabetes is a progressive disease characterised by a decline in ?-cell function and loss of glycaemic control, with many patients ultimately requiring intensification of their treatment regimen.
“Guidelines for the treatment of patients with type 2 diabetes suggest that tight glycaemic control should be maintained – defined as glycated haemoglobin (HbA1c) less than 7.0% (53 mmol/mol) – through active titration of combinations of antihyperglycaemic medications and lifestyle modification, as appropriate.
“Additional antihyperglycaemic drugs may be added if the HbA1c level continues to remain above the recommended target of 7.0%.
“If HbA1c is greater than 7.5% (58 mmol/mol), further intensification, including the use of insulin, is recommended.
“As people with diabetes move through the recommended treatment algorithm, those patients who are suboptimally controlled according to the guideline targets may be at greater risk of long-term diabetes-related complications.
“Of the 11,000 patients we studied, only a third of those needing further medication were actually given it.
“Clinical inertia is a global phenomenon, which is putting people with Type 2 diabetes at further risk of preventable complications associated with the condition.”
The retrospective cohort study investigated whether clinical inertia exists in people with type 2 diabetes treated with basal insulin.
It involved 11,696 patients with type 2 diabetes in the UK Clinical Practice Research Datalink database between January 2004 and December 2011, with follow-up until December 2013.
Prof Khunti added: “In conclusion, the present study shows that there is a significant delay in the intensification of treatment in people with type 2 diabetes with poor glycaemic control, and that many patients do not have their treatment intensified at all.
“Clinical inertia appears to exist at both the initiation and intensification of insulin therapy.
“This may have a negative impact on the long-term outcomes for patients.
“More detailed studies, perhaps using patient and physician questionnaires, should attempt to establish the reasons for a delay in intensification, particularly among elderly people with diabetes and those with comorbidities.”
The study was published in the journal Diabetes, Obesity and Metabolism.
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