Clinical inertia to insulin initiation and intensification in the UK: A focused literature review

Prim Care Diabetes. 2017 Feb;11(1):3-12. doi: 10.1016/j.pcd.2016.09.003. Epub 2016 Oct 7.

Abstract

Achieving tight glycaemic control early following the diagnosis of type 2 diabetes is key to optimising clinical outcomes, yet many patients and clinicians are reluctant to initiate and intensify insulin therapy. Reasons for this arise primarily from a lack of time, clinical expertise and patient understanding. However, meaningful progress can be achieved with self-management educational programmes soon after diagnosis. Clinician education and training, along with easy-to-use and well-tolerated therapies (for example, those carrying a low risk of hypoglycaemia and/or avoiding weight gain), may also increase the likelihood of patient adherence.

Keywords: Clinical inertia; Insulin intensification; Type 2 diabetes guidelines.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel
  • Biomarkers / blood
  • Blood Glucose / drug effects*
  • Blood Glucose / metabolism
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Glycated Hemoglobin A / metabolism
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Hypoglycemic Agents / administration & dosage*
  • Hypoglycemic Agents / adverse effects
  • Insulin / administration & dosage*
  • Insulin / adverse effects
  • Medication Adherence
  • Patient Education as Topic
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'*
  • Self Care
  • Treatment Outcome
  • United Kingdom

Substances

  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin
  • hemoglobin A1c protein, human