Table 1.
List of inappropriate practices in the therapy, diagnosis and procedures of patients with type 2 diabetes failing BOT
| Practice/procedure | 1 | 2 | 3 | 4 | 5 | Weighted score |
|---|---|---|---|---|---|---|
| 1. Do not delay treatment changes in patients who fail to achieve their glycemic targets | 2.7% | – | 4.1% | 26.0% | 67.1% | 4.55 |
| 2. Do not start basal-bolus insulin therapy and keep it long term without attempting alternative therapeutic strategies | 4.1% | 2.7% | 12.3% | 34.2% | 46.6% | 4.16 |
| 3. Do not use sulfonylureas-glinides—Do not neglect the use of SGLT2 inhibitors and/or GLP-1RAs in patients with high CV risk | 4.1% | – | 2.7% | 17.8% | 75.3% | 4.60 |
| 4. Do not prescribe a sulfonylurea if no possible therapeutic alternative has been used | 4.1% | 5.5% | 11.0% | 19.2% | 60.3% | 4.26 |
| 5. Do not underdose first-line metformin therapy | 2.7% | 8.2% | 31.5% | 38.4% | 19.2% | 3.63 |
| 6. Do not ignore the use of GLP-1RAs in therapeutic strategies | 2.7% | 1.4% | 5.5% | 23.3% | 67.1% | 4.51 |
| 7. Do not routinely determine the C-peptide in hospitalized patients | 15.1% | 21.9% | 31.5% | 21.9% | 9.6% | 2.89 |
| 8. Do not prescribe C-peptide before starting insulin therapy | 12.3% | 26.0% | 42.5% | 13.7% | 5.5% | 2.74 |
| 9. Do not prescribe pancreatic enzymes before and during therapy with GLP-1RAs and DPP-4 inhibitors | 11.0% | 26.0% | 32.9% | 21.9% | 8.2% | 2.90 |
| 10. Do not leave SU when starting insulin therapy | 4.1% | 6.8% | 13.7% | 19.2% | 56.2% | 4.16 |
| 11. Do not discontinue metformin treatment with basal-bolus (unless there is a problem with glomerular filtrate) | 4.1% | 4.1% | 30.1% | 37.0% | 24.7% | 3.74 |
| 12. Do not start the insulin before the GLP-1RAs | 4.1% | 5.5% | 26.0% | 39.7% | 24.7% | 3.75 |
| 13. Do not underestimate the risk of lack of hypoglycemia awareness | – | 4.1% | 5.5% | 19.2% | 71.2% | 4.58 |
| 14. Do not prescribe metformin without first assessing the eGFR and/or the risk of acute renal failure | 2.7% | – | 9.6% | 20.5% | 67.1% | 4.49 |
| 15. Do not delay the intensification of diabetes therapy | 2.7% | – | 1.4% | 30.1% | 65.8% | 4.56 |
| 16. Do not underestimate the benefit of personalization of therapy in relation to the patient's comorbidities (i.e., CV risk factors) | 2.7% | – | 4.1% | 24.7% | 68.5% | 4.56 |
| 17. Do not forget to stratify the patient's CV risk | 2.7% | – | 6.8% | 34.2% | 56.2% | 4.41 |
| 18. Do not consider the cost of therapy rather than the cost of the disease | 11.0% | 15.1% | 23.3% | 20.5% | 30.1% | 3.44 |
| 19. Do not consider exclusively the 'glycaemia' endpoint in the management of the disease, neglecting cardiovascular and renal protection | 5.5% | 1.4% | 6.8% | 17.8% | 68.5% | 4.42 |
| 20. Do not leave out the PK and PD characteristics of the drug to limit glycemic variability | 2.7% | 6.8% | 27.4% | 39.7% | 23.3% | 3.74 |
| 21. Do not use the "sliding scale" insulin scheme by modifying the insulin dosage on the basis of pre-meal or bed-time blood sugar levels | 6.8% | 8.2% | 26.0% | 27.4% | 31.5% | 3.68 |
| 22. Do not continue oral hypoglycemic therapy at home in acute patients in hospital | 2.7% | 2.7% | 19.2% | 26.0% | 49.3% | 4.16 |
| 23. Do not administer insulin by syringe. both in the hospital and at home | 6.8% | 8.2% | 17.8% | 23.3% | 43.8% | 3.89 |
| 24. Do not underestimate the importance of adequate titration of insulin or combinations with basal insulin | 2.7% | 4.1% | 2.7% | 26.0% | 64.4% | 4.45 |