Clinical inertia in the management of type 2 diabetes mellitus: a focused literature review

Abstract

Achieving tight glycaemic control early on in the disease trajectory has been shown to have beneficial effects on macrovascular and microvascular complications and mortality in people with type 2 diabetes. International guidelines recommend individualised targets for glycaemic control, but many people with type 2 diabetes are not adequately reaching these targets. One major reason for not achieving these targets is 'clinical inertia', defined as 'failure of healthcare providers to initiate or intensify therapy when indicated'. This article gives an overview of clinical inertia in the management of type 2 diabetes, relating to the initiation of oral antidiabetic and insulin therapies, reasons for clinical inertia and strategies for overcoming clinical inertia. Br J Diabetes Vasc Dis 2015;15:65-69

Effect of Multifactorial Treatment Targets and Relative Importance of Hemoglobin A1c, Blood Pressure, and Low‐Density Lipoprotein‐Cholesterol on Cardiovascular Diseases in Chinese Primary Care Patients With Type 2 Diabetes Mellitus: A Population‐Based Retrospective Cohort Study

“…Clinical inertia has been postulated to be the main reason underlying the low prevalence of multitarget control. Clinical inertia refers to a failure or reluctance to initiate or intensify therapies when clinically indicated . The causes for clinical inertia can be complex and multifactorial involving both clinician and patient barriers .…”

“…Clinical inertia refers to a failure or reluctance to initiate or intensify therapies when clinically indicated . The causes for clinical inertia can be complex and multifactorial involving both clinician and patient barriers . At the clinician level, barriers include time constraints for consultation, concern about the potential risk of harm, and lack of information and training needed to achieve therapeutic goals.…”

Temporal changes in glycaemic thresholds for treatment intensification in type 2 diabetes in an urban Australian setting: the Fremantle Diabetes Study

“…16 In the case of insulin, an HbA 1c threshold well in excess of 8.0% (64 mmol/mol) has been found in a range of observational studies, but as with OHA, guidelines may not advocate the introduction of insulin therapy until the HbA 1c is above this level. Most involve an assessment of addition of OHA beyond monotherapy since (and in contradistinction to Australian recommendations on the value of a period of lifestyle modification 5 ) metformin is increasingly prescribed at the time of diagnosis in type 2 diabetes, with the thresholds prompting OHA intensification recommended in national guidelines varying between 6.5% and 8.0% (48 and 64 mmol/mol).…”

When basal insulin is not enough: successful strategies for insulin intensification in patients with type 2 diabetes mellitus

“…Одной из основных при-чин недостижения целей терапии является «клиническая инерция». Это термин, определяемый как «отказ медицин-ских работников инициировать или интенсифицировать терапию, когда это показано» [20]. Понятие клинической инерции комплексное, причинами могут быть барьеры на уровне врача, пациента и системы здравоохранения.…”

“…Исследования подчеркивают, что феномен клиниче-ской инерции -это постоянная и реально существующая проблема, несмотря на наличие ясных клинических реко-мендаций с четко прописанными целями терапии. Внедре-ние в практику этих рекомендаций могло бы быть ценным как начальная ступень в принятии клинического решения, однако практика показывает, что клиническая инерция су-щественно не меняется с годами, несмотря на убедитель-ные доказательства преимуществ жесткого гликемическо-го контроля [20].…”