Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review

May combine two claims.

In Thailand, 26.2% of patients with T2DM showed clinical inertia, with HbA1c levels at or above 7.0% for periods ranging from 1.6 to 7 years until intensification took place.

“In Thailand, 26.2% of patients with T2DM showed clinical inertia, with HbA1C levels ≥7.0% for periods ranging from 1.6 to 7 years, until intensification took place [16].”

• cites [16] Kaewbut, 2020, An observational study of clinical inertia among patients with type 2 diabetes mellitus in a tertiary care hospital, Arch. Med. Sci. sourcePartly supported

  The Results report clinical inertia in 261 of 994 enrolled T2DM outpatients (26.2%) in Thailand. The Methods define it using HbA1c ≥7.00% and no treatment intensification at the index date or subsequent prescription; the paper does not report a 1.6-to-7-year delay until intensification. Page numbers were not provided in our copy. (LLM, conf=0.91)

  Experimental — accuracy not yet measured

May combine two claims.

Causes of therapeutic inertia are complex, multifactorial, and observed at three levels: provider, patient, and system barriers, which account for 50%, 30%, and 20% of therapeutic inertia causes, respectively.

“Causes for therapeutic inertia are complex, multifactorial, and can be observed at three levels: the provider’s level, the patient’s level, and the system barriers level, which account for 50%, 30%, and 20% of therapeutic inertia causes, respectively [13].”

• cites [13] Khunti, 2019, Therapeutic inertia in type 2 diabetes: Prevalence, causes, consequences and methods to overcome inertia, Ther. Adv. Endocrinol. Metab. sourceSupported

Classified as probably not a substantial claim.

Clinical guidelines recommend monitoring HbA1c every three months with frequent therapy modification until the glycemic goal is achieved.

“Clinical guidelines recommend the monitoring of HbA1c every three months with frequent therapy modification until the glycemic goal is achieved [5].”

• cites [5] Bellou, V., Belbasis, L., Tzoulaki, I., and Evangelou, E. (2018). Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses. PLoS ONE, 13. sourceCould not verify

  The Discussion addresses factors associated with developing type 2 diabetes, and the Results assess evidence for those associations; neither addresses clinical monitoring after diagnosis. Searches for HbA1c monitoring every three months and therapy modification found no passage in our copy stating the claimed guideline recommendation. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

May combine two claims.

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].”

• cites [10] Andreozzi, 2020, Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: A narrative literature review, Diabetol. Metab. Syndr. sourcePartly supported

  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)

  Experimental — accuracy not yet measured

May combine two claims.

At the system level, healthcare issues, high costs, poor communication and coordination between departments, inadequate support technologies or insurance coverage, and regional differences of norms are important causes of therapeutic inertia.

“At the system level, healthcare issues, high costs, poor communication and coordination between the departments, inadequate support technologies or insurance coverage, and regional differences of norms are some important causes of therapeutic inertia [13].”

• cites [13] Khunti, 2019, Therapeutic inertia in type 2 diabetes: Prevalence, causes, consequences and methods to overcome inertia, Ther. Adv. Endocrinol. Metab. sourcePartly supported

  The “Causes of therapeutic inertia > System level” section identifies healthcare-system issues, medication costs, differences between healthcare settings, and insurance coverage as barriers. It does not identify poor coordination between departments, inadequate support technologies, or regional differences in norms as causes. The copy provides no page numbers for these passages. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

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.”

• cites [10] Andreozzi, 2020, Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: A narrative literature review, Diabetol. Metab. Syndr. sourceCould not verify

  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)

  Experimental — accuracy not yet measured

May combine two claims.

At the provider level, lack of time, poor knowledge, varied or frequent guidelines, and fear of side effects such as hypoglycemia are major causes of therapeutic inertia.

“At the provider’s level, lack of time, poor knowledge, varied or frequent guidelines, and fear of side effects such as hypoglycemia in diabetic patients are the major causes of therapeutic inertia.”

• cites [13] Khunti, 2019, Therapeutic inertia in type 2 diabetes: Prevalence, causes, consequences and methods to overcome inertia, Ther. Adv. Endocrinol. Metab. sourceSupported

May combine two claims.

Mata-Cases et al. found a median time for treatment intensification of 17.1 months for HbA1c levels of 8.0-9.9% and 10.1 months for HbA1c levels above 10%.

“Mata-Cases et al. [35] found a median time for treatment intensification of 17.1 months for HbA1c levels of 8.0–9.9% and 10.1 months for HbA1c levels above 10%.”

• cites [35] Real, 2018, Therapeutic inertia in patients treated with two or more antidiabetics in primary care: F actors predicting intensification of treatment, Diabetes Obes. Metab. sourcePartly supported

  Section 3.4 reports that median time to intensification decreased as HbA1c increased, and the passage accompanying Figure 1A gives 10.1 months for patients with HbA1c ≥10%. Our copy does not give the claimed 17.1-month median for the 8.0–9.9% group. It also defines the higher group as ≥10%, rather than strictly above 10%. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

May combine two claims.

Clinical inertia is detrimental to therapeutic success in the management of T2DM and would result in the development of complications.

“Clinical inertia is detrimental to therapeutic success in the management of T2DM, and it would result in the development of complications [11].”

• cites [11] Okemah, 2018, Addressing Clinical Inertia in Type 2 Diabetes Mellitus: A Review, Adv. Ther. sourceSupported

May combine two claims.

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].”

• cites [21] Lang, 2015, Family physician clinical inertia in glycaemic control among patients with type 2 diabetes, Med. Sci. Monit. sourcePartly supported

  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 measured
• cites [43] Ziemer, 2005, Clinical Inertia Contributes to Poor Diabetes Control in a Primary Care Setting, Diabetes Educ. sourceNot checked — no full text of the source

May combine two claims.

Clinical inertia speeds up progression to complications such as diabetic retinopathy and reduced life expectancy.

“Clinical inertia results in poor glycemic control and speeds up the progression to complications such as diabetic retinopathy and reduced life expectancy [11,29].”

• Also stated in: § 4. Discussion · plain

  “Clinical inertia results in poor glycemic control and speeds up the progression of diabetic retinopathy (shorter duration than that of non-inertia group).”

• cites [11] Okemah, 2018, Addressing Clinical Inertia in Type 2 Diabetes Mellitus: A Review, Adv. Ther. sourceSupported
• cites [29] Osataphan, 2016, Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: A retrospective cohort study, J. Diabetes sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

The 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”

• cites [20] Khunti, 2014, Clinical Inertia in People with Type 2 Diabetes: A Retrospective Cohort Study of More Than 80,000 People, Diabetes Care sourceNot checked — no full text of the source
• cites [21] Lang, 2015, Family physician clinical inertia in glycaemic control among patients with type 2 diabetes, Med. Sci. Monit. sourceSupported
• cites [22] Balkau, 2016, Reasons for non-intensification of treatment in people with type 2 diabetes receiving oral monotherapy: Outcomes from the prospective DIAttitude study, Ann. d’Endocrinol. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

A longer duration of diabetes is associated with clinical inertia.

“For example, Khunti et al. [31] reported that a longer duration was associated with clinical inertia, while Mata-Cases et al. [35] reported that diabetes duration ≥ 20 years was associated with treatment intensification.”

• cites [31] Khunti, 2016, Clinical inertia with regard to intensifying therapy in people with type 2 diabetes treated with basal insulin, Diabetes Obes. Metab. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

A longer duration of diabetes is associated with treatment intensification.

“Similarly, Lanzinger et al. [24] reported that a longer duration of diabetes was associated with treatment intensification.”

• cites [24] Lanzinger, 2018, Clinical inertia among patients with type 2 diabetes mellitus treated with DPP-4i and/or SGLT-2i, Diabetes Res. Clin. Pract. sourceSupported

May combine two claims.

The highest clinical inertia was reported in a study conducted in the United States despite high healthcare spending in the USA.

“Surprisingly the level of clinical inertia levels seen here were not related to health spending; for example, the highest clinical inertia was reported in a study conducted in the United States despite the high healthcare spending in USA [32].”

• cites [32] Seidu, 2018, Therapeutic inertia amongst general practitioners with interest in diabetes, Prim. Care Diabetes sourcePartly supported

  The Discussion reports a Michigan study in which 27% of patients had sustained hyperglycaemia without medication intensification; the Results report therapeutic inertia in 22.1% of this paper’s UK patients. The paper does not establish that the US study had the highest level of clinical inertia, nor does it compare that level with US healthcare spending. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

Low quality of care may result in visit-to-visit HbA1c variability among type 2 diabetes mellitus patients and relatively fewer outpatient visits.

“Low quality of care may result in visit-to-visit HbA1c variability among T2DM patients and relatively fewer outpatient visits.”

• cites [45] Qu, 2022, Visit-to-visit glycated hemoglobin A1c variability in adults with type 2 diabetes: A systematic review and meta-analysis, Chin. Med. J. sourcePartly supported

  The Discussion (page unavailable) says high HbA1c variability in people with type 2 diabetes may reflect lower quality of care. It does not establish that low-quality care causes the variability, and the passages found do not link it to fewer outpatient visits. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [46] Fenton, 2006, Quality of Preventive Care for Diabetes: Effects of Visit Frequency and Competing Demands, Ann. Fam. Med. sourcePartly supported

  The Discussion (page unavailable) reports that patients with infrequent outpatient visits were less likely to receive timely diabetes preventive care. The paper measures receipt of HbA1c tests, not visit-to-visit HbA1c variability, and does not establish that low-quality care causes fewer visits; it examines visit patterns as predictors of preventive care. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Six studies were conducted in the USA and included 141,714 patients.

“Six studies were conducted in the United States of America (USA) and included 141,714 patients.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Fourteen included studies had more than 50% male patients.

“Fourteen studies had more than 50% of male patients.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most patients in the included studies were aged 60 years or above.

“Most patients were aged 60 years or above.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The included studies used different designs: 15 retrospective, 4 prospective, 5 cross-sectional, and 1 qualitative.

“Fifteen studies used a retrospective design, four studies used a prospective design, five studies used a cross-sectional design, and one study used a qualitative study design.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The included studies were conducted between 2004 and 2021.

“These studies were conducted between 2004 and 2021 and represented 575,067 patients diagnosed with T2DM.”

• Also stated in: § 3.1. Selection and Descriptive Assessment · plain

  “This review thus includes 25 studies (Table 4) published from 2004 to 2021.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The initial literature search identified 3196 studies, and the review concluded a final list of 25 studies.

“The initial literature search identified 3196 studies, but this review concluded a final list of only 25 studies.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The initial search identified 3196 studies, containing 574 duplicate studies; 2437 had titles or abstracts only, shortening the list to 185; of these, 160 did not fulfill the inclusion criteria.

“The comprehensive databases (PubMed, Embase, Medline, and Cochrane Central Register of Controlled Trials) initial search identified 3196 studies, which contained 574 duplicate studies. Another 2437 studies had titles or abstracts only, which shortened the list to 185. Of these, 160 studies did not fulfill the defined inclusion criteria.”

May combine two claims.

In the UK, clinical inertia ranged from 22.1% to 69.1%, with an average of 45.6%.

“In the UK, clinical inertia ranged from 22.1% to 69.1%.”

• Also stated in: § 3.4. Clinical Inertia Prevalence · plain

  “It was at a lower percentage in the UK, where clinical inertia ranged from 22.1% to 69.1% (average 45.6%).”

• AssumptionRests on an assumption: The clinical inertia criteria used by the included studies are sufficiently comparable to permit summarizing prevalence across studies.

May combine two claims.

In Spain, clinical inertia ranged from 18.1% to 60.0%, with an average of 39.0%.

“In Spain, clinical inertia ranged from 18.1% to 60%.”

• Also stated in: § 3.4. Clinical Inertia Prevalence · plain

  “It was even lower in France and Spain, where clinical inertia ranged from 31.0% to 42.3% (average 36.6%) and 18.1% to 60.0% (average 39.0%), respectively.”

• AssumptionRests on an assumption: The clinical inertia criteria used by the included studies are sufficiently comparable to permit summarizing prevalence across studies.

May combine two claims.

In the USA, clinical inertia ranged from 35.4% to 85.8%, with an average of 60.6%.

“In the USA, clinical inertia ranged from 35.4% to 85.8%.”

• Also stated in: § 3.4. Clinical Inertia Prevalence · plain

  “In the USA, clinical inertia ranged from 35.4% to 85.8% (average 60.6%).”

• AssumptionRests on an assumption: The clinical inertia criteria used by the included studies are sufficiently comparable to permit summarizing prevalence across studies.

May combine two claims.

In Croatia, Colombia, Germany, Australia, Taiwan, and Malaysia, clinical inertia was reported at prevalence percentages lower than 60.0% at 55.7%, 56.9%, 55.6%, 38.3%, and 54.6%, respectively.

“On the other hand, countries including Croatia, Colombia, Germany, Australia, Taiwan, and Malaysia reported clinical inertia at prevalence percentages lower than 60.0% at 55.7%, 56.9%, 55.6%, 38.3%, and 54.6%, respectively.”

• AssumptionRests on an assumption: The clinical inertia criteria used by the included studies are sufficiently comparable to permit summarizing prevalence across studies.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Six studies were conducted in the UK and included 214,516 patients.

“Six were in the United Kingdom (UK) and included 214,516 patients.”

Probably not a substantial claim: may not pass S3 (load-bearing).

One study was conducted internationally across six countries, including Brazil, India, Japan, Spain, the UK, and the USA, and had 652 patients.

“One study in the list was conducted internationally across six countries (including Brazil, India, Japan, Spain, the UK, and the USA) and had 652 patients.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Use of comedications predicts the likelihood of treatment intensification or reduced clinical inertia.

“However, they reported that a higher CCI score, POS insurance, high index HbA1c, baseline endocrinologist visit, and use of comedications predict the likelihood of treatment intensification or reduced clinical inertia.”

• cites [34] Lin, 2016, Does Clinical Inertia Vary by Personalized A1C Goal? A Study of Predictors and Prevalence of Clinical Inertia In A U.S. Managed-Care Setting, Endocr. Pract. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

One included study interviewed 19 physicians and one nurse involved in managing T2DM patients to identify perceptions about clinical inertia from primary healthcare providers.

“One of these studies interviewed 19 physicians and one nurse who had been involved in managing T2DM patients to identify and explore perceptions about clinical inertia from the perspective of the primary healthcare providers.”

Classified as probably not a substantial claim. May combine two claims.

The review identified aspects of clinical inertia including prevalence, time to treatment intensification, reasons for non-intensification, perceptions of primary care providers, patterns and predictors of intensification, effect on glycemic control, and factors associated with delayed treatment.

“The aspects that were identified by this review included the prevalence of clinical inertia; the time to treatment intensification; the potential reasons for clinical inertia or treatment non-intensification among physicians and patients; the perceptions of primary care providers about clinical inertia; the patterns and predictors of treatment intensification; the effect of clinical inertia on”

Probably not a substantial claim: may not pass S3 (load-bearing).

Another included study included 109 family physicians to determine clinical inertia existence in family medicine practice among patients with T2DM requiring insulin therapy.

“Another study included 109 family physicians to determine clinical inertia existence in family medicine practice among patients with T2DM requiring insulin therapy.”

May combine two claims. The quote only partly states this claim.

Factors associated with clinical inertia identified in the review include patient reluctance, fear of side effects, higher percentage of HbA1c, OAD started by diabetologist, patients using more than OADs, longer duration of diabetes, increased postprandial glycemia, total cholesterol, patient physical inactivity, communication gaps between physicians and patients, older age, zero DCSI, zero CIC, C

“The identified factors included patient reluctance, a fear of side effects, a higher percentage of HbA1c, OAD started by diabetologist, patients using more than OADs, a longer duration of diabetes, an increased postprandial glycemia, total cholesterol, patient physical inactivity, communication gaps between the physicians and patients, older age, zero diabetes comorbidity severity index (DCSI),”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Spain and France each had two studies, with 37,502 and 1,971 patients, respectively.

“Spain and France each had two studies with 37,502 and 1971 patients, respectively.”

Probably not a substantial claim: may not pass S3 (load-bearing).

One study across Germany and Australia had 4,576 diabetic patients treated with DPP-4 inhibitors and/or SGLT-2 inhibitors.

“There was one study across both Germany and Australia with 4576 diabetic patients treated with dipeptidyl peptidase-4 inhibitors (DPP-4i) and/or sodium/glucose cotransporter 2 inhibitors (SGLT-2i).”

May combine two claims.

Most participants could offer relevant explanations of the concept of clinical inertia despite being unaware of the term.

“Surprisingly, Zafar et al. [27] reported that most of the participants (physician or nurse) were unaware of the term “clinical inertia” or its meaning, but they could offer relevant explanations of the concept.”

• cites [27] Zafar, 2015, Acknowledging and allocating responsibility for clinical inertia in the man-agement of type 2 diabetes in primary care: A qualitative study, Diabet. Med. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Single studies were conducted in Croatia (10,275 patients), Colombia (363 patients), Taiwan (168,876 patients), Thailand (98 patients), Brazil (323 patients), Malaysia (7,646 patients), and Canada (379 patients).

“In Croatia (10,275 patients), Colombia (363 patients), Taiwan (168,876 patients), Thailand (98 patients), Brazil (323 patients), Malaysia (7646 patients), and Canada (379 patients), only one study was conducted.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The included studies interviewed a variety of healthcare practitioners, mainly family physicians.

“The included studies interviewed a variety of healthcare practitioners, mainly family physicians.”

May combine two claims.

Higher Charlson Comorbidity Index score, Point-of-Service insurance, high index HbA1c, baseline endocrinologist visit, and use of comedications were associated with a reduced likelihood of clinical inertia.

“In contrast, a higher Charlson Comorbidity Index (CCI) score, Point-of-Service (POS) insurance, a high index HbA1c, a baseline endocrinologist visit, and the use of comedications were associated with a reduced likelihood of clinical inertia [34].”

• cites [34] Lin, 2016, Does Clinical Inertia Vary by Personalized A1C Goal? A Study of Predictors and Prevalence of Clinical Inertia In A U.S. Managed-Care Setting, Endocr. Pract. sourceNot checked — no full text of the source

May combine two claims.

Some physicians defended their patients by referring to a lack of knowledge and took responsibility for not improving their patients' awareness.

“Even some physicians defended their patients by referring to a lack of knowledge and taking the responsibility by not improving their patients’ awareness.”

• cites [27] Zafar, 2015, Acknowledging and allocating responsibility for clinical inertia in the man-agement of type 2 diabetes in primary care: A qualitative study, Diabet. Med. sourceNot checked — no full text of the source

May combine two claims.

Patient-level barriers to treatment intensification include non-compliance to prescribed medications, failure to attend appointments, conflicting priorities, lack of awareness about the fatality of type 2 diabetes mellitus, lack of symptoms, human error, comorbidities, polypharmacy, complex nature of the disease, deprivation, and communication barrier.

“At the patient level, barriers included non-compliance to prescribed medications, failure to attend appointments, conflicting priorities (such as perceptions, beliefs, or work commitments), lack of awareness about the fatality of T2DM, lack of symptoms, human error, comorbidities, polypharmacy, complex nature of the disease, deprivation, and communication barrier [27].”

• cites [27] Zafar, 2015, Acknowledging and allocating responsibility for clinical inertia in the man-agement of type 2 diabetes in primary care: A qualitative study, Diabet. Med. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Some physicians think they should be firmer to reach the target HbA1c.

“They also think that they should be a bit firmer to reach the target HbA1c [27].”

• cites [27] Zafar, 2015, Acknowledging and allocating responsibility for clinical inertia in the man-agement of type 2 diabetes in primary care: A qualitative study, Diabet. Med. sourceNot checked — no full text of the source

May combine two claims.

Clinical inertia exists at the provider, patient, and system levels.

“Clinical inertia not only exists at the provider or patient level but also at the system level as well.”

Probably not a substantial claim: may not pass S4 (based).

Clinical inertia can change across different health systems and countries.

“It also shows how clinical inertia can change across different health systems and countries.”

May combine two claims.

Reasons for non-intensification include therapeutic failure, poor adherence to lifestyle modifications, poor compliance to medications, patient reluctance to intensify treatment, fear of side effects, poor self-monitoring, and cost.

“Reasons for non-intensification include therapeutic failure, poor adherence to lifestyle modifications, poor compliance to medications, patient reluctance to intensify treatment, fear of side effects (such as hypoglycemia, gastrointestinal disturbance, oedema, or weight gain), poor self-monitoring, and cost [37].”

• cites [37] Simon, 2012, Therapeutic inertia in type 2 diabetes: Insights from the PANORAMA study in France, Diabetes Metab. sourceNot checked — no full text of the source

May combine two claims.

System-level barriers to treatment intensification include time constraints, workload pressures, and lack of expertise.

“At the system level, barriers included time constraints, workload pressures, and lack of expertise.”

May combine two claims.

Inertia was remarkably higher in patients with mean HbA1c close to the target (7-8%) or those at initial steps of diabetes management such as lifestyle modification and monotherapy.

“Studies show that inertia was remarkably higher in patients with mean glycated hemoglobin (HbA1c) close to the target (i.e., 7–8%) or those at the initial steps of diabetes management such as lifestyle modification and monotherapy [14].”

• cites [14] Saez, 2013, Clinical inertia in the treatment of hyperglycemia in type 2 diabetes patients in primary care, Curr. Med. Res. Opin. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The title and abstract of searched-for studies were reviewed initially by two independent reviewers to ascertain that included articles met the inclusion criteria.

“The title and abstract of searched-for studies were reviewed initially by two independent reviewers to ascertain that all included articles were in line with the inclusion criteria utilizing the PRISMA statement recommendations (Figure 2); these were then followed by a full-text review.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Risk of bias in the included studies was assessed by the Newcastle-Ottawa scale, which consists of selection, comparability, and outcome assessment domains.

“The risk of bias in the studies was assessed by the Newcastle–Ottawa scale (NOS) [19], which consists of three domains: (1) selection, (2) comparability, and (3) assessment of the outcome(s).”

• cites [19] Wells, G.A., Shea, B., O’Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2000). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses, University of Ottawa.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Disagreements between independent reviewers regarding search results and study inclusion were resolved by a third independent reviewer through discussion.

“If any disagreement arose between the independent reviewers regarding the search results and study inclusion, it was resolved by a third independent reviewer through discussion.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The review followed the PRISMA checklist and PRISMA flow diagram.

“This review utilized the recommendations outlined in the Performed Reporting Items for Systemic review and Meta-Analyses (PRISMA) statement by following the PRISMA checklist and PRISMA flow diagram [18].”

• cites [18] Statement, P. (2021, March 29). PRISMA Statement. Available online: https://www.prisma-statement.org/Default.aspx.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Studies with a Newcastle-Ottawa scale score of 6 or higher were considered high quality.

“Studies with an NOS score ≥6 were considered high quality.”

May combine two claims.

Clinical inertia can have negative consequences for type 2 diabetes mellitus patients, which may contribute to poor prognosis.

“This study shows that clinical inertia can have negative consequences for T2DM patients, which may contribute to poor prognosis.”

Probably not a substantial claim: may not pass S3 (load-bearing).

This study could not address the effect of the COVID-19 pandemic on type 2 diabetes mellitus clinical inertia.

“Regarding COVID19 effects on patients, practitioners, and systems, this study could not address the effect of COVID 19 pandemic on T2DM clinical inertia.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The provider-to-provider relationship has an important role to play in patient management.

“In addition to the provider-to-patient relationship that was noted by this review, the provider-to-provider relationship has an important role to play in patient management as well.”

May combine two claims.

The studies used in this review were published between 2004 and 2021; only three studies were conducted in 2020 and 2021.

“The studies used here were published between 2004 and 2021; only three studies were conducted in 2020 and 2021.”

May combine two claims.

In Italy, the Associazione Medici Diabetologi-annals initiative is a cost-saving method of improving clinical outcomes in type 2 diabetes mellitus patients because it improves HbA1c, blood pressure, lipid profiles, and BMI compared to conventional management methods.

“In Italy, the long-term projections of the Associazione Medici Diabetologi-annals initiative (a physician-led quality-of-care improvement program for T2DM patients) indicate that this initiative is a cost-saving method of improving clinical outcomes in T2DM patients because it improves HbA1c, blood pressure, lipid profiles, and BMI in enrolled patients compared to conventional management methods [”

• cites [47] Giorda, 2013, Improving quality of care in people with Type 2 diabetes through the Associazione Medici Diabetologi-annals initiative: A long-term cost-effectiveness analysis, Diabet. Med. sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

This review presents pooled study findings conducted across 14 different geographical areas and may be considered broadly representative of type 2 diabetes mellitus clinical inertia.

“This review presents pooled study findings conducted across 14 different geographical areas and may be considered broadly representative of the T2DM clinical inertia.”

May combine two claims.

Interprofessional education and interprofessional collaboration have a positive impact on chronic disease management including type 2 diabetes mellitus, resulting in quality-of-care improvement and enhanced delivery of patient care.

“Interprofessional education (IPE) and interprofessional collaboration (IPC) have a positive impact on chronic disease management including T2DM, which results in quality-of-care improvement and an enhancement in the delivery of patient care [44].”

• cites [44] Pascucci, 2020, Impact of interprofessional collaboration on chronic disease management: Findings from a systematic review of clinical trial and meta-analysis, Health Policy sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

This review lacks a quantitative approach.

“This review lacks a quantitative approach.”