Time to do more: Addressing clinical inertia in the management of type 2 diabetes mellitus

Abstract

The principal findings of this survey suggest that impairments in communication are at the heart of clinical inertia. This manuscript lays out four key principles that we believe are achievable in all environments and can improve the lives of people with diabetes.

Patients’ Future Expectations for Diabetes and Hypertension Treatments: “Through the Diet… I Think This is Going to Go Away.”

“…28 Providers should consider initiating discussions regarding the importance of initiating, continuing, and intensifying therapy for individuals with hypertension and diabetes early in the disease course. 17,27,29,30 Providing patients with information about the rationale for medication intensification may help them anticipate changes in their regimen, and thus be more receptive to them. 28 However, having such discussions may be time-consuming, since we also previously showed that among these participants, about 40 % were less likely to start a diabetes medication if they were informed of the medication's time requirements, and the estimated 10-year lag before the risk of complications is reduced.…”

“…Prior studies have found that patients hold inaccurate beliefs about diabetes and hypertension, which negatively impact decision-making. [14][15][16][17][18] For example, some patients with hypertension believe that they only have hypertension when they experience symptoms, and stop taking medications when they are asymptomatic. 14,15 Patients who believe they are not at risk for complications from diabetes and hypertension have been found to be less willing to intensify their medications when necessary.…”

“…16 In other studies, patients who believe that insulin leads to diabetic complications are more likely to resist initiation of insulin therapy. 17,18 While many studies have described patient knowledge of diabetes and hypertension and its impact on treatment adherence, [14][15][16][17][18] few studies have explored patient expectations for treating their conditions in the future. One study of African American patients with high blood pressure found that 38 % believed they would not need to take medication for life, 19 and a study of low-income African American and Latino patients with diabetes found that almost one-third believed a doctor would cure them of diabetes.…”

Evaluation of the self-eye examination method for health promotion

“…However, simple and cheap actions such as the ophthalmologic exam made by qualified personnel, in spite of not being specialists, allows the diagnosis and treatment of ocular conditions with early referrals for ophthalmologists (10) . Studies conducted in different nations reveal that deficient knowledge in eye health care can contribute to the onset of blindness (11) . Globally, functional presbyopia affected 194.7 million people aged up to 35 years, and 666.7 million older than 50 years.…”

The Role of Real-Time Glucose Monitoring

“…One likely contributor to this phenomenon is clinical inertia, or the failure to intensify or modify treatment following lab results that show a patient is not at evidence-based goals. Stain et al [3] found that impairments in communication are at the heart of clinical inertia [3]. Furthermore, it can be difficult to accurately assess disease progression due to poor documentation and communication of patient-monitored blood sugars.…”