‘Phenomenon’ leading to poor diabetes control

Many people with Type 2 diabetes are not “adequately” reaching individual targets for blood sugar levels because of the continuing “phenomenon” of ‘clinical inertia’, researchers have concluded.

International guidelines recommend tailored targets for glycaemic control, but many people with Type 2 diabetes are not meeting these, the article published in The British Journal of Diabetes & Vascular Disease stated.

One major reason for missing personalised goals is ‘clinical inertia’, defined as “failure of healthcare providers to initiate or intensify therapy when indicated”, according to Clinical inertia in the management of type 2 diabetes mellitus: a focused literature review.

This despite achieving tight glycaemic control early on in the condition having been shown to have beneficial effects on complications and mortality.

The article gives an overview of clinical inertia in the management of Type 2 diabetes, relating to the initiation of oral antidiabetic and insulin therapies, reasons for clinical inertia and strategies for overcoming it.

The researchers – including Leicester Diabetes Centre Co-Directors Professor Melanie Davies and Professor Kamlesh Khunti and Sachin Khunti from University of Portsmouth – said: “These studies highlight the phenomenon of clinical inertia as a continuing and significant problem, despite the availability of clear guidelines proposing specific therapeutic targets. Implementing guideline recommendations would be valuable as an initial step, but the evidence shows that clinical inertia has not improved significantly over the years, despite good evidence of tight glycaemic control.

“Type 2 diabetes is a chronic condition with an increasing prevalence and tight glycaemic control and medication optimisation should occur in a timely manner to reduce long-term complications. The evidence summarised above demonstrates that clinical inertia is common both with oral antidiabetic agents (OAD) and insulin-based therapies.”

They concluded that a number of factors were associated with inertia, including lack of knowledge, training, and education for both healthcare professionals and people with diabetes, along with inadequate resources.