Clinical inertia, reverse clinical inertia, and medication non-adherence in type 2 diabetes
- 225 Downloads
Clinical inertia and medication non-adherence are thought to contribute largely to the suboptimal glycemic control in many patients with type 2 diabetes. The present review explores the relations between A1C targets, clinical inertia and medication non-adherence in type 2 diabetes.
We searched PubMed for English-language studies published from 2001 through June 1, 2018. We also manually searched the references of selected articles, reviews, meta-analyses, and practice guidelines. Selected articles were mutually agreed upon by the authors.
Clinical inertia is the failure of clinicians to initiate or intensify therapy when indicated, while medication non-adherence is the failure of patients to start or continue therapy that a clinician has recommended. Although clinical inertia may occur at all stages of diabetes treatment, the longest delays were reported for initiation or intensification of insulin. Medication non-adherence to antidiabetic drugs may range from 53 to 65% at 1 year and may be responsible for uncontrolled A1C in about 23% of cases. Reverse clinical inertia can be acknowledged as the failure to reduce or change therapy when no longer needed or indicated. Clinical inertia and medication non-adherence are difficult to address: clinician-and patient-targeted educational programs, more connected communications between clinicians and patients, the help of other health professional figures (nurse, pharmacist) have been explored with mixed results.
Both clinical inertia and medication non-adherence remain significant barriers to optimal glycemic targets in type 2 diabetes. Moreover, part of clinical inertia may be a way through which clinicians face current uncertainty in medicine, including some dissonance among therapeutic guidelines. Scientific associations should find an agreement about how to measure and report clinical inertia in clinical practice and should exhort clinicians to consider reverse clinical inertia as a cause of persisting inappropriate therapy in vulnerable patients.
KeywordsClinical inertia Rreverse clinical inertia Medication non-adherence Failing HbA1c targets
All authors contributed equally to this review.
The present research was supported in part by the Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, and the “Associazione Salute con Stile”, Naples, Italy.
Compliance with ethical standards
Conflict of interest
D.G. received honoraria for speaking at meetings from Novartis, Sanofi-Aventis, Lilly, AstraZeneca. M.I.M. received honoraria for speaking at meetings from Astra-Zeneca, Sanofi-Aventis. G.B.declared no conflict of interest. K.E. received honoraria for speaking at meetings from Novartis, Sanofi-Aventis, Lilly, AstraZeneca, Boehringer Ingelheim.
This manuscript is a review of the literature and does not contain original research either on animal or on human subjects.
For this type of manuscript, informed consent is not required.
- 9.Zoungas S, Arima H, Gerstein HC et al (2017) Collaborators on Trials of Lowering Glucose (CONTROL) group. Effects of intensive glucose control on microvascular outcomes in patients with type 2 diabetes: a meta-analysis of individual participant data from randomized controlled trials. Lancet Diabetes Endocrinol 5:431–437CrossRefGoogle Scholar
- 16.National Committee for Quality Assurance (2015) The state of health care quality 2015 [E-pub]. National Committee for Quality Assurance, Washington, DC. http://store.ncqa.org/index.php/catalog/product/view/id/2341/s/2015-state-of-health-carequality-report/. Accessed 30 Apr 2018
- 38.Alatorre C, Fernández Landó L, Yu M et al (2017) Treatment patterns in patients with type 2 diabetes mellitus treated with glucagon-like peptide-1 receptor agonists: higher adherence and persistence with dulaglutide compared with once-weekly exenatide and liraglutide. Diabetes Obes Metab 19:953–961CrossRefGoogle Scholar
- 47.Forbes CA, Deshpande S, Sorio-Vilela F et al (2018) A systematic literature review comparing methods for the measurement of patient persistence and adherence. Curr Med Res Opin 17:1–27Google Scholar
- 48.Qaseem A, Wilt TJ, Kansagara D, Horwitch C, Barry MJ, Forciea MA, For the Clinical Guidelines Committee of the American College of Physicians (2018) Hemoglobin A1c targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: a guidance statement update from the American College of Physicians. Ann Intern Med 168:569–576CrossRefGoogle Scholar
- 56.Cleveringa FG, Gorter KJ, van den Donk M, van Gijsel J, Rutten GE (2013) Computerized decision support systems in primary care for type 2 diabetes patients only improve patients’ outcomes when combined with feedback on performance and case management: a systematic review. Diabetes Technol Ther 15:180–192CrossRefGoogle Scholar
- 58.Bieszk N, Reynolds SL, Wei W, Davis C, Kamble P, Uribe C (2016) “Act on Threes” paradigm for treatment intensification of type 2 diabetes in managed care: results of a randomized controlled study with an educational intervention targeting improved glycemic control. J Manag Care Spec Pharm 22:1028–1038PubMedGoogle Scholar
- 61.Garber AJ, Abrahamson MJ, Barzilay JI et al (2018) AACE/ACE Consensus Statement. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm—2018 executive summary. Endocr Pract 24:91–120CrossRefGoogle Scholar
- 70.Kleinman NJ, Shah A, Shah S, Phatak S, Viswanathan V (2017) Improved medication adherence and frequency of blood glucose self-testing using an m-Health platform versus usual care in a multisite randomized clinical trial among people with type 2 diabetes in India. Telemed J E Health 23:733–740CrossRefGoogle Scholar
- 71.QuintilesIMS Institute. Outlook for global medicines through 2021 [Internet], 2016. http://static.correofarmaceutico.com/docs/2016/12/12/qiihi_outlook_for_global_medicines_through_2021.pdf. Accessed 9 May 2018
- 73.Qaseem A, Barry MJ, Humphrey LL, Forciea MA; for the Clinical Guidelines Committee of the American College of Physicians (2017) Oral pharmacologic treatment of type 2 diabetes mellitus: a clinical practice guideline update from the American College of Physicians. Ann Intern Med 166:279–290CrossRefGoogle Scholar
- 76.(2011) Guiding the guidelines. Lancet 377:1125Google Scholar