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

Diabetes Res Clin Pract. 2014 Sep;105(3):302-12. doi: 10.1016/j.diabres.2014.05.005. Epub 2014 May 27.

Abstract

Aims: Clinical inertia, the tendency to maintain current treatment strategies despite results demanding escalation, is thought to substantially contribute to the disconnect between clinical aspirations for patients with diabetes and targets achieved. We wished to explore potential causes of clinical inertia among physicians and people with diabetes.

Methods: A 20-min online survey of 652 adults with diabetes and 337 treating physicians in six countries explored opinions relating to clinical inertia from both perspectives, in order to correlate perceptions and expectations relating to diagnosis, treatment, diabetes complications and therapeutic escalation.

Results: Physicians had low expectations for their patients, despite the belief that the importance of good glycaemic control through lifestyle and pharmacological interventions had been adequately conveyed. Conversely, people with diabetes had, at best, a rudimentary understanding of the risks of complications and the importance of good control; indeed, only a small proportion believed lifestyle changes were important and the majority did not intend to comply.

Conclusions: 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.

Keywords: Clinical inertia; Hypoglycaemia; Type 2 diabetes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Attitude of Health Personnel*
  • Data Collection
  • Diabetes Complications / prevention & control*
  • Diabetes Complications / psychology*
  • Diabetes Complications / therapy
  • Diabetes Mellitus, Type 2 / psychology*
  • Diabetes Mellitus, Type 2 / therapy*
  • Disease Management
  • Female
  • Health Communication / methods*
  • Humans
  • Hypoglycemia / complications
  • Male
  • Middle Aged
  • Patient Acuity
  • Patient Compliance
  • Treatment Outcome