Addressing Clinical Inertia in Type 2 Diabetes Mellitus: A Review

Abstract

The current epidemic of type 2 diabetes (T2D) represents a significant global and national health concern. Globally, the prevalence of diabetes has doubled between 1980 and 2014. In 2014 the World Health Organization estimated that there were 422 million adults living with diabetes worldwide. In the USA, the number of people diagnosed with T2D is estimated to increase to over 70 million by 2050, putting an immense strain on the US healthcare system. Achieving glycemic control is widely acknowledged as the key goal of treatment in T2D and is critical for reducing the onset and progression of diabetes-related complications such as cardiovascular diseases, neuropathies, retinopathies, and nephropathies. Despite the increase in the availability of antihyperglycemic medications and evidence-based treatment guidelines, the proportion of people with T2D who fail to achieve glycemic goals continues to rise. One major contributor is a delay in treatment intensification despite suboptimal glycemic control, referred to as clinical or therapeutic inertia. Clinical inertia prolongs the duration of patients’ hyperglycemia which subsequently puts them at increased risk of diabetes-associated complications and reduced life expectancy. Clinical inertia results from a complex interaction between patient, healthcare providers, and healthcare system barriers that need to be addressed together, rather than as separate entities. In this article we provide an overview of clinical inertia in the clinical management of T2D and provide suggestions for overcoming aspects that may have a negative impact on patient care.Funding: Sanofi US, Inc.

The impact of phenotype, ethnicity and genotype on progression of type 2 diabetes mellitus

“…There was a wide variation in how diabetes progression was defined, with most of the studies defining it as the initiation of insulin with others defining it as the initiation of any OHA or treatment intensification. These prescription‐based analyses can be affected by clinical inertia for prescribing “insulin.” Clinical inertia originates as a result of the complex interaction between patient, provider and health system factors and which delays the appropriate treatment regimes . The Multinational Diabetes Attitudes Wishes and Needs (DAWN) study representing 13 countries reported the reluctance among healthcare professionals to prescribe insulin .…”

Oral semaglutide versus injectable glucagon-like peptide-1 receptor agonists: a cost of control analysis

“…Data from the National Health and Nutrition Examination Survey (NHANES) in the US show that only 50.9% of people with diabetes had HbA1c levels lower than 7.0% in the 2011-2014 cohort (N ¼ 1,325) 20 . Failure to intensify treatment despite not achieving glycemic control targets may be due to therapeutic inertia, increasing the time patients spend in sub-optimal glycemic control, and therefore increasing the risk of diabetes-related complications 21 . Therefore, there is a significant opportunity to improve care for people with type 2 diabetes, and thereby reduce the clinical and economic burden of the disease.…”

Is therapeutic inertia present in primary diabetes care in Malaysia? A prospective study

“…Clinical inertia is defined as a failure to initiate or intensify necessary treatments at a timely manner when faced with objective evidence of uncontrolled diseases in the present of clear clinical practice guidelines [17][18][19]. Therapeutic inertia, although used interchangeably with clinical inertia, focuses more on the prescribed therapies and pharmacological agents, and usually construed as the providers' failure to increase therapy when treatment targets are not met [20].…”