Therapeutic inertia in type 2 diabetes: prevalence, causes, consequences and methods to overcome inertia

Khunti, Sachin; Khunti, Kamlesh; Seidu, Samuel

doi:10.1177/2042018819844694

Cited by 110 publications

(143 citation statements)

References 50 publications

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“…Nursing staff can help in case of poor compliance or anxiety associated with therapeutic problems, such as self-administration of injectable drugs [60]. Finally, it is possible to improve adherence to therapies through reminder systems and apps that support the patient in managing their diabetes [57].…”

Section: Box 3-epidemiology Of Clinical Inertia In Diabetes Carementioning

confidence: 99%

“…Health professionals-related barriers It is fundamental to identify the subjects at higher risk of delay in the intensification of the treatments [56]. Several studies have documented that active feedback to healthcare professionals and the introduction of specific informatic remainders are able to reduce the time of therapeutic intensification [57]. Proactive approaches with patients also prove useful, as patients respond better when they feel they contribute to a positive outcome [58].…”

Section: Box 4-how Can We Overcome the Barriers Of Clinical Inertia?mentioning

confidence: 99%

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Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: a narrative literature review

Andreozzi

Candido

Corrao

et al. 2020

Diabetol Metab Syndr

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Diabetes mellitus is a chronic disease characterized by high social, economic and health burden, mostly due to the high incidence and morbidity of diabetes complications. Numerous studies have shown that optimizing metabolic control may reduce the risk of micro and macrovascular complications related to the disease, and the algorithms suggest that an appropriate and timely step of care intensification should be proposed after 3 months from the failure to achieve metabolic goals. Nonetheless, many population studies show that glycemic control in diabetic patients is often inadequate. The phenomenon of clinical inertia in diabetology, defined as the failure to start a therapy or its intensification/de-intensification when appropriate, has been studied for almost 20 years, and it is not limited to diabetes care, but also affects other specialties. In the present manuscript, we have documented the issue of inertia in its complexity, assessing its dimensions, its epidemiological weight, and its burden over the effectiveness of care. Our main goal is the identification of the causes of clinical inertia in diabetology, and the quantification of its social and health-related consequences through the adoption of appropriate indicators, in an effort to advance possible solutions and proposals to fight and possibly overcome clinical inertia, thus improving health outcomes and quality of care.

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Section: Box 3-epidemiology Of Clinical Inertia In Diabetes Carementioning

confidence: 99%

Section: Box 4-how Can We Overcome the Barriers Of Clinical Inertia?mentioning

confidence: 99%

Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: a narrative literature review

Andreozzi

Candido

Corrao

et al. 2020

Diabetol Metab Syndr

View full text Add to dashboard Cite

show abstract

“…Reasons for treatment delays can stem from the healthcare system, the practitioner, and the patient. In the UK, these barriers include competing demands on practitioner time, financial constraints of the NHS (particularly in relation to the costs of newer medications), patient adherence, and concerns over side effects [35]. Intensification to insulin is particularly challenging because of the complexity of administration, the level of instruction required, and patient concerns around the use of injectable treatments [36].…”

Section: Implications For Clinicians and Policymakersmentioning

confidence: 99%

Ethnic disparities in initiation and intensification of diabetes treatment in adults with type 2 diabetes in the UK, 1990–2017: A cohort study

et al. 2020

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Background Type 2 diabetes mellitus (T2DM) disproportionately affects individuals of nonwhite ethnic origin. Timely and appropriate initiation and intensification of glucose-lowering therapy is key to reducing the risk of major vascular outcomes. Given that ethnic inequalities in outcomes may stem from differences in therapeutic management, the aim of this study was to identify ethnic differences in the timeliness of initiation and intensification of glucose-lowering therapy in individuals newly diagnosed with T2DM in the United Kingdom.

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“…Therapeutic or clinical inertia is the failure to advance or intensify therapy when appropriate to do so [42]. To avoid therapeutic inertia, guidelines recommend reviewing glycaemic control every 3-6 months, and intensifying treatment (moving down the treatment algorithm) if indicated [4,6].…”

Section: Avoiding Therapeutic Inertiamentioning

confidence: 99%

Dulaglutide and Insulin: How Can the AWARD Studies Help Guide Clinical Practice?

MacIsaac

2020

Diabetes Ther

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The glucagon-like peptide 1 receptor agonist (GLP-1RA) dulaglutide has many characteristics to recommend it both as a second-line agent and as an alternative to or in combination with insulin. This commentary summarises recent updates to diabetes management guidelines regarding the use of GLP-1RAs such as dulaglutide, both as a second-line agent and as a firstline injectable agent in type 2 diabetes (T2D). It also examines how the Assessment of Weekly AdministRation of LY2189265 [dulaglutide] in Diabetes (AWARD) studies with dulaglutide and insulin may help to guide clinical practice for the use of dulaglutide as an alternative to basal insulin or in combination with insulin. Individualising glucose-lowering therapy is important in patients with T2D, especially given patients' heterogeneity in terms of age, lifestyle, disease duration, level of hyperglycaemia and comorbidities. Choice of therapy should be guided by clinical considerations (e.g. high risk or existing cardiovascular [CV] disease, heart failure, chronic kidney disease, risk of hypoglycaemia), side effect profile, contraindications, patient preferences and cost. The recently updated American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) guidelines now recommend adding a GLP-1RA with proven CV benefit to metformin in patients with T2D and indicators of high risk or established atherosclerotic CV disease. The AWARD studies demonstrate that dulaglutide provides effective glucose lowering together with sustained weight loss and a low incidence of hypoglycaemia when used as the first injectable option and when used in combination with titrated basal insulin or prandial insulin, providing a valid treatment option across a wide range of patients with T2D, including those with chronic kidney disease.

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Therapeutic inertia in type 2 diabetes: prevalence, causes, consequences and methods to overcome inertia

Cited by 110 publications

References 50 publications

Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: a narrative literature review

Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: a narrative literature review

Ethnic disparities in initiation and intensification of diabetes treatment in adults with type 2 diabetes in the UK, 1990–2017: A cohort study

Dulaglutide and Insulin: How Can the AWARD Studies Help Guide Clinical Practice?

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