Clinical inertia in patients with T2DM requiring insulin in family practice.
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
OBJECTIVE: To describe the clinical status of patients with type 2 diabetes mellitus (T2DM) in the primary care setting at insulin initiation and during follow-up, and to assess the efficacy of insulin initiation and intensification. DESIGN: Ontario FPs from the IMS Health database who had prescribed insulin at least once in the 12 months before November 2006 were randomly selected to receive an invitation to participate. Eligible and consenting FPs completed a questionnaire for each of up to 10 consecutive eligible patients. Patient data were recorded from 3 time points. SETTING: Family practices in Ontario, Canada. PARTICIPANTS: One hundred and nine FPs and 379 of their T2DM patients taking insulin (with or without oral agents). MAIN OUTCOME MEASURES: Glycated hemoglobin (HbA₁(c)) levels, daily insulin dose, and use of concomitant oral agents at insulin initiation and 2 subsequent visits. RESULTS: Data from each patient were obtained on insulin initiation and intensification, glycemic control, further pharmacologic therapy, and related complications. Mean time from diagnosis of T2DM to insulin initiation was 9.2 years. Mean HbA₁(c) values were 9.5% before insulin initiation, 8.1% at visit 2 (median 1.2 years later), and 7.9% at visit 3 (median 3.9 years after initiation). Mean insulin dose was 24 units at initiation, 48 units at visit 2, and 65 units at visit 3. At visit 3, 20% of patients continued to have very poor glycemic control (HbA₁(c) > 9.0%). With the exception of a decrease in sulfonylurea use, concomitant use of oral antihyperglycemic agents remained static over time. CONCLUSION: Even in patients identified as being sufficiently high risk to warrant insulin therapy, a clinical care gap exists in physician efforts to achieve and sustain recommended HbA₁(c) target levels. Family physicians need strategies to facilitate earlier initiation and ongoing intensification of insulin therapy.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it