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

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Andreozzi, F., Candido, R., Corrao, S., Fornengo, R., Giancaterini, A., Ponzani, P., Ponziani, M. C., Tuccinardi, F. +1 more·2020·Diabetology & Metabolic Syndrome
DOI 10.1186/s13098-020-00559-7PMC PMC7301473
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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.

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  • At the patient level, concerns over drug side effects, misunderstanding treatment regimens, comorbidities, terminal illnesses, trypanophobia, limited doctor-patient relationship, low education level, and socioeconomic status are major barriers to therapeutic intensification.

    “At the patient level, concerns over drug side effects, misunderstanding the different treatment regimens, comorbidities, terminal illnesses, trypanophobia, a limited doctor–patient relationship, low education level, and socioeconomic status are major barriers for therapeutic intensification [10].”

    From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [10]

    The “Patient-related factors (Table 1)” section lists side effects, difficulty following complex regimens, limited doctor–patient communication, low education, socioeconomic status, and terminal illnesses as barriers. It does not identify trypanophobia as a barrier, and Table 1 places failure to identify and manage comorbidities under clinician-related rather than patient-related factors. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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  • Clinical inertia is a remarkable barrier to therapeutic success because it delays the intensification of treatment.

    “In terms of optimal management of diabetes, clinical inertia is a remarkable barrier to therapeutic success, because it delays the intensification of treatment [10].”

    From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [10]

  • In about 30% of individuals, impaired glucose tolerance or impaired fasting glucose progresses to diabetes.

    “In about 30% of the individuals, IGT or impaired fasting glucose (IFG) progresses to diabetes.”

    From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [10]

    The Key Summary Points discuss diabetes prevalence, and Box 3 discusses treatment intensification among people who already have diabetes; neither gives a progression rate for IGT or IFG. The References list studies of diabetes prevention in people with impaired glucose tolerance, but our copy does not state that about 30% of people with IGT or IFG progress to diabetes (searched: IGT, IFG, impaired glucose tolerance, impaired fasting glucose, and 30%). (LLM, conf=0.75)

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Research works printed but not linked: 3

  1. [40]Annals of AMD 2018. Assessment of AMD diabetes quality assistence indicators in Italy; 2018. https://aemmedi.it/wp-content/uploads/2019/05/AMD-Monografia-SGLT-2i-web-protetto.pdf. Accessed 27 Sept 2019.
  2. [51]Monographs of the Annals of AMD 2012. Focus on changes to treatment in type 2 diabetes. 2012. http://www.infodiabetes.it/files/ANNALI-AMD/2013/Annali%202013%20Terapie%20per%20web.pdf. Accessed 5 Nov 2019.
  3. [52]González-Clemente JM Font B Lahoz R Llauradó G Gambús G Grupo de investigadores del Estudio INERCIA INERTIA study: Clinical inertia in non-insulinized patients on oral hypoglycemic treatment. A study in Spanish primary and specialty care settings Med Clin (Barc). 2014 142 478 484 23622897

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Authors
Andreozzi, F., Candido, R., Corrao, S., Fornengo, R., Giancaterini, A., Ponzani, P., Ponziani, M. C., Tuccinardi, F., & Mannino, D.
Affiliations
  • Magna Graecia University (IT)
  • Azienda Sanitaria Universitaria Integrata di Trieste (IT)
  • University of Palermo (IT)
  • Azienda ospedaliera "Bianchi-Melacrino-Morelli" (IT)
Corresponding author
Andreozzi, F.
ORCID
Venue
Diabetology & Metabolic Syndrome
Publisher
Springer Science and Business Media LLC
Published
2020-06-17
Volume
12
Issue
1
Pages
52-52
ISSN
1758-5996 (ISSN-L)
DOI
10.1186/s13098-020-00559-7
PMC
PMC7301473
OpenAlex
W3036158386
Cited by
128
References
89
Citations by year
2026: 12 · 2025: 16 · 2024: 27 · 2023: 25 · 2022: 22 · 2021: 23 · 2020: 2 · 2019: 1
FWCI
2.76
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetology & Metabolic Syndrome (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion, other-oa)
Funders
MSD Italia
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
clinical inertia, diabetes mellitus, glycemic control, diabetes complications, microvascular complications, macrovascular complications, treatment intensification, quality of care, health outcomes

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