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Diabetes Metab. 2017 Dec;43(6):501-511. doi: 10.1016/j.diabet.2017.06.003. Epub 2017 Jul 25.

Clinical inertia and its impact on treatment intensification in people with type 2 diabetes mellitus.

Author information

1
Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital APHP and EA 3412, CRNH-IdF, Paris 13 University, 93017 Bobigny, France. Electronic address: gerard.reach@aphp.fr.
2
Lilly Diabetes, Eli Lilly & Company, 92521 Neuilly-sur-Seine, France.
3
Eli Lilly Italia, Sesto Fiorentino, 50019 Florence, Italy.
4
U.O. Diabetologia e Malattie Metaboliche, Multimedica IRCCS Sesto San Giovanni, 20099 Milan, Italy.

Abstract

Many people with type 2 diabetes mellitus (T2DM) fail to achieve glycaemic control promptly after diagnosis and do not receive timely treatment intensification. This may be in part due to 'clinical inertia', defined as the failure of healthcare providers to initiate or intensify therapy when indicated. Physician-, patient- and healthcare-system-related factors all contribute to clinical inertia. However, decisions that appear to be clinical inertia may, in fact, be only 'apparent' clinical inertia and may reflect good clinical practice on behalf of the physician for a specific patient. Delay in treatment intensification can happen at all stages of treatment for people with T2DM, including prescription of lifestyle changes after diagnosis, introduction of pharmacological therapy, use of combination therapy where needed and initiation of insulin. Clinical inertia may contribute to people with T2DM living with suboptimal glycaemic control for many years, with dramatic consequences for the patient in terms of quality of life, morbidity and mortality, and for public health because of the huge costs associated with uncontrolled T2DM. Because multiple factors can lead to clinical inertia, potential solutions most likely require a combination of approaches involving fundamental changes in medical care. These could include the adoption of a person-centred model of care to account for the complex considerations influencing treatment decisions by patients and physicians. Better patient education about the progressive nature of T2DM and the risks inherent in long-term poor glycaemic control may also reinforce the need for regular treatment reviews, with intensification when required.

KEYWORDS:

Clinical inertia; Patient-related factors; Physician-related factors; System-related factors; Treatment outcomes; Type 2 diabetes mellitus

PMID:
28754263
DOI:
10.1016/j.diabet.2017.06.003
[Indexed for MEDLINE]
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