Family Physician Clinical Inertia in Glycemic Control among Patients with Type 2 Diabetes
Open accessAbstract
BACKGROUND: Many patients with diabetes do not achieve target values. One of the reasons for this is clinical inertia. The correct explanation of clinical inertia requires a conjunction of patient with physician and health care system factors. Our aim was to determine the rate of clinical inertia in treating diabetes in primary care and association of patient, physician, and health care setting factors with clinical inertia. MATERIAL AND METHODS: This was a national, multicenter, observational, cross-sectional study in primary care in Croatia. Each family physician (FP) provided professional data and collected clinical data on 15-25 type 2 diabetes (T2DM) patients. Clinical inertia was defined as a consultation in which treatment change based on glycated hemoglobin (HbA1c) levels was indicated but did not occur. RESULTS: A total of 449 FPs (response rate 89.8%) collected data on 10275 patients. Mean clinical inertia per FP was 55.6% (SD ±26.17) of consultations. All of the FPs were clinically inert with some patients, and 9% of the FPs were clinically inert with all patients. The main factors associated with clinical inertia were: higher percentage of HbA1c, oral anti-diabetic drug initiated by diabetologist, increased postprandial glycemia and total cholesterol, physical inactivity of patient, and administration of drugs other than oral antidiabetics. CONCLUSIONS: Clinical inertia in treating patients with T2DM is a serious problem. Patients with worse glycemic control and those whose therapy was initiated by a diabetologist experience more clinical inertia. More research on causes of clinical inertia in treating patients with T2DM should be conducted to help achieve more effective diabetes control.
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The review found two conflicting results: Lang et al. reported that patients with worse glycemic control and those whose therapy was initiated by a diabetologist experienced more clinical inertia, whereas Ziemer et al. reported less clinical inertia at the diabetes clinic (35%) versus the medical clinic (67%).
“The review also came across two conflicting results, where Lang et al. reported that the patients with worse glycemic control and those whose therapy was initiated by a diabetologist experienced more clinical inertia [21], which contrasted with what Ziemer et al. reported, which was less clinical inertia at the diabetes clinic (35%) versus the medical clinic (67%) [43].”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [21]
Split into 2 atoms — 1 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredIn Croatia, patients whose therapy was initiated by a diabetologist experienced worse glycemic control than patients managed by other family physicians.
“Surprisingly, in Croatia, Lang et al. [21] reported that patients whose therapy was initiated by a diabetologist experienced a worse glycemic control and higher clinical inertia than patients who were managed by other family physicians.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [21]
The Results (Clinical inertia; page unavailable) report that patients whose oral antidiabetic therapy was initiated by a diabetologist had a higher risk of clinical inertia. They separately report that patients with worse glycemic control were more likely to experience clinical inertia, but do not establish that the diabetologist-initiated group had worse glycemic control than patients whose therapy was initiated by family physicians. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe criteria for clinical inertia included poor glycemic control indicated by mean HbA1c above target, failure to initiate or intensify treatment timely when indicated by HbA1c, lack of individualization of treatment goals, failure to initiate or intensify according to evidence-based guidelines, and failure to initiate or intensify therapy when indicated.
“The criteria for clinical inertia included poor glycemic control as indicated by mean HbA1c levels above the recommended target levels [20], failure to initiate or intensify treatment in a timely manner as indicated by a consultation in which treatment change based on HbA1c levels is indicated but does not occur [21], lack of individualization of treatment goals for some patients [22], failure to”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [21]
In Croatia, patients whose therapy was initiated by a diabetologist experienced higher clinical inertia than patients managed by other family physicians.
“Surprisingly, in Croatia, Lang et al. [21] reported that patients whose therapy was initiated by a diabetologist experienced a worse glycemic control and higher clinical inertia than patients who were managed by other family physicians.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [21]
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- Authors
- Kranjčević, K.
- Affiliations
- General Practice Office, Zagreb-Zapad Health Care Center, Zagreb, Croatia
- Corresponding author
- Kranjčević, Ksenija
- Venue
- Medical Science Monitor
- Published
- 2015
- Volume
- 21
- Pages
- 403-411
- ISSN
- 1234-1010 (ISSN-L)
- 1643-3750
- PMC
- PMC4329939
- OpenAlex
- W2045757121
- Cited by
- 39
- References
- 26
- Citations by year
- 2026: 1 · 2024: 3 · 2023: 3 · 2022: 7 · 2021: 2 · 2020: 4 · 2019: 4 · 2018: 5 · 2017: 8 · 2016: 2
- FWCI
- 4.35
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Medical Science Monitor (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- clinical inertia, type 2 diabetes, glycemic control, HbA1c, general practitioners, primary care, oral antidiabetic drugs, postprandial blood glucose, physical inactivity, total cholesterol
- MeSH terms
- Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Practice Patterns, Physicians', Physicians, Family, Surveys and Questionnaires, Logistic Models, Croatia
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