Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: a narrative literature review

Abstract

Diabetes mellitus is a chronic disease characterized by high social, economic and health burden, mostly due to the high incidence and morbidity of diabetes complications. Numerous studies have shown that optimizing metabolic control may reduce the risk of micro and macrovascular complications related to the disease, and the algorithms suggest that an appropriate and timely step of care intensification should be proposed after 3 months from the failure to achieve metabolic goals. Nonetheless, many population studies show that glycemic control in diabetic patients is often inadequate. The phenomenon of clinical inertia in diabetology, defined as the failure to start a therapy or its intensification/de-intensification when appropriate, has been studied for almost 20 years, and it is not limited to diabetes care, but also affects other specialties. In the present manuscript, we have documented the issue of inertia in its complexity, assessing its dimensions, its epidemiological weight, and its burden over the effectiveness of care. Our main goal is the identification of the causes of clinical inertia in diabetology, and the quantification of its social and health-related consequences through the adoption of appropriate indicators, in an effort to advance possible solutions and proposals to fight and possibly overcome clinical inertia, thus improving health outcomes and quality of care.

An example of clinical inertia in geriatrics

“…We can partially overcome the clinical inertia by introducing interventions, including a patient education. [ 23 24 ]…”

From the Association of Diabetes Care & Education Specialists: The Role of the Diabetes Care and Education Specialist as a Champion of Technology Integration

“…Combined, these technologies create opportunities for the diabetes care and education specialist to engage in person-centered and contextualized care and education while providing tailored feedback to address and mitigate therapeutic inertia. 19-21…”

“…Use of this continually updated resource will ensure that every individual is offered an appropriate technology that facilitates improved outcomes and quality of life. 20…”

Insulin therapy is a personalized approach to glycemic management in diabetes

“…В Российской Федерации уровень адекватного гликемического контроля колеблется в диапазоне 40-60% [2,3], что несколько выше, чем в Китае [4], но существенно уступает показателям развитых стран, где уровень удовлетворительного гликемического контроля достигает 70-90% и более [5]. Среди факторов, препятствующих удовлетворительному контролю гликемии у больных СД на территории России, в первую очередь следует отметить субъективные: низ-Инсулинотерапия -персонализированный подход к управлению гликемией при сахарном диабете Ò.Þ.…”