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.

Keywords: Clinical inertia; Therapeutic inertia; Treatment intensification; Type 2 diabetes.

Fig. 1

Consequences of delayed intervention in patients without previous CVD. Reproduced with permission from Khunti. K & Millar-Jones. D. Clinical inertia to insulin initiation and intensification in the UK: A focused literature review. Primary Care Diabetes. 2017, 11: 3–12 [8] © 2016 The Authors. The risk of CVD is shown for patients with HbA1c consistently above 53 mmol/mol (> 7.0%) in the 2 years following diagnosis for whom treatment intensification is delayed by at least 1 year versus that of patients with HbA1c consistently below 53 mmol/mol (< 7.0%) in the same period [14]. CI confidence interval, CVD cardiovascular disease, CVE cardiovascular event, HbA1c, glycated hemoglobin, HF heart failure, IT intensification of treatment, MI myocardial infarction. Illustration based on data from [14]. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)

Fig. 2

Patient and physician-related barriers [, –27]