Clinical Inertia in Individualising Care for Diabetes: Is There Time to do More in Type 2 Diabetes?

Abstract

Clinical inertia is defined as the failure to establish appropriate targets and escalate treatment to achieve treatment goals. It accounts for a significant proportion of failure to achieve targets in the management of diabetes and contributes to up to 200,000 adverse diabetes- related outcomes per year. Despite a growing awareness of the phenomenon, and newer, better-tolerated agents for the control of diabetes, there has been little improvement over the last decade in the prevalence of clinical inertia. Although common-place in clinical practice, clinical inertia does not appear to affect clinical trials. There are lessons that may be translated from these randomised controlled trials to clinical practice, which that may improve the care for those with diabetes. Key amongst these interventions are good education, clear treatment strategy and more time for interaction between physician and patients, all of which appears to reduce clinical inertia as evidenced by the “placebo effect” of clinical trials. We plan to review here, the lessons that can be learnt from clinical trials and how these may translate to better care for people with diabetes.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-014-0077-8) contains supplementary material, which is available to authorized users.

Poor control and management of type 2 diabetes mellitus at an under-resourced South African Hospital: is it a case of clinical inertia?

“…8 Clinical inertia is the failure to set glycaemic targets and to implement and escalate treatment to achieve these set target goals. 12 Clinical inertia is a global phenomenon and the causes are related to patient and physician factors and factors related to the system in which the physicians work. 12 Evidence from both developed and developing countries shows that, even with the implementation of evidence-based medicine, the attainment of optimal glycaemia control is difficult and challenging not only for patients but also for their healthcare providers.…”

“…12 Clinical inertia is a global phenomenon and the causes are related to patient and physician factors and factors related to the system in which the physicians work. 12 Evidence from both developed and developing countries shows that, even with the implementation of evidence-based medicine, the attainment of optimal glycaemia control is difficult and challenging not only for patients but also for their healthcare providers. 7,[13][14][15][16][17] Coupled with these multifactorial reasons for poor glycaemia control and clinical inertia, 12 South Africa has the added burden of being an under-resourced country, leading to an increase in long-term diabetic complications.…”

“…12 Evidence from both developed and developing countries shows that, even with the implementation of evidence-based medicine, the attainment of optimal glycaemia control is difficult and challenging not only for patients but also for their healthcare providers. 7,[13][14][15][16][17] Coupled with these multifactorial reasons for poor glycaemia control and clinical inertia, 12 South Africa has the added burden of being an under-resourced country, leading to an increase in long-term diabetic complications. Further, the outpatients' department of Port Shepstone Regional Hospital (PSRH), where the study was conducted, had 3 908 visits by patients with DM in 2010.…”

Technology Driven Diabetes Management: Application of Cellular Transmission of Glucose Data

“…The clinical study investigators were able to respond to the SMBG with time to assess the information before communicating with the participant addressing the issue of clinical inertia and individualizing care [14]. For nine of the ten participants, there was an absolute reduction in A1C.…”

Quelle est la stratégie idéale pour traiter l’hyperglycémie du diabète de type 2 ?

“…Devant une maladie le plus souvent asymptomatique, il n'est guère étonnant que l'observance thérapeutique soit largement imparfaite chez bon nombre de patients DT2. Ce manque d'adhésion est sans doute plus marqué dans les conditions de vie réelle que dans les conditions artificielles des essais cliniques contrôlés réalisés chez des patients sélectionnés et particulièrement bien surveillés (11) . Limiter le phénomène de la mauvaise adhésion au traitement représente un défi majeur, reconnu par l'Organisation Mondiale de la Santé pour toutes les maladies chroniques dont le DT2 (12) .…”