Strategies to Overcome Therapeutic Inertia in Type 2 Diabetes Mellitus: A Scoping Review

Abstract

Therapeutic inertia in the management of type 2 diabetes mellitus is common, with causes at the patient, health-care professional and health-care system levels. The majority of recent strategies to address therapeutic inertia usually consisted of multiple interventions, but rarely targeted more than 1 level. Most strategies used educational interventions among patients or health-care professionals, but gaps were found in addressing determinants of behaviour change.

Kidney Disease in Diabetic Patients: From Pathophysiology to Pharmacological Aspects with a Focus on Therapeutic Inertia

“…A review performed by Wrzal et al [ 130 ] showed how in-person education is still the most relevant approach toward patients and between clinicians (54%), while technology still has a secondary role, with e-learning (14%), electronic medical records (8%), or mobile applications (18%). Interestingly, no educational intervention has focused on explaining the drugs’ side effects to the patients or reassuring them about the risk of hypoglycemia, rather showing a conservative approach of clinicians to therapeutic decisions.…”

“…Interestingly, no educational intervention has focused on explaining the drugs’ side effects to the patients or reassuring them about the risk of hypoglycemia, rather showing a conservative approach of clinicians to therapeutic decisions. The main outcomes measured in the intervention group were improved glycated hemoglobin levels, a higher proportion of intensified therapies with insulin or GLP-1-RA, or better results in the knowledge tests provided [ 130 ].…”

“…The need for new strategies to address this problem has been recently highlighted in several randomized and cluster-randomized controlled studies or prospective cohort trials, aiming to establish appropriate strategies directed to either the patient, clinician and/or, system levels, with only 28% of studies contemporarily addressing several levels [ 130 ].…”

Web-based intervention to reduce psychological barriers to insulin therapy among adults with non-insulin-treated type 2 diabetes: study protocol for a two-armed randomised controlled trial of ‘Is insulin right for me?’

“…9 10 Reasons for the delay of treatment intensification are multifaceted, 7 11 12 and effective interventions targeting barriers to insulin use are required. [13][14][15] At a systemic or health professional level, promising results have been shown using multidisciplinary models of care (eg, an enhanced practice nurse role within primary care setting 9 ), effective consultation strategies (eg, collaborative approach to care 16 ) and insulin-specific structured education programmes. 17 18 However, there is a parallel need for interventions, which directly target the psychological barriers (negative beliefs and attitudes) to insulin held by the person with T2D.…”

CRS Diabetes: An Effective Model for Improving Family Medicine Resident Knowledge, Competence, and Performance in Diabetes Care

“…Clinician-related factors include ever-evolving guidelines and treatment goals, new treatment options, formulary and insurance restrictions, time constraints during patient visits, clinicianpatient communication issues, complexities in patient disease management resulting from multiple comorbid diseases, concerns about adverse events and treatment complexity, and lack of a multidisciplinary diabetes care team (16)(17)(18)(19). Lack of knowledge regarding evolving evidence-based treatment and inability to confidently integrate this knowledge into clinical practice are key barriers to improving clinician factors that contribute to therapeutic inertia (20).…”