Clinical Inertia: The Role of Physicians in Diabetes Outcomes

  • Joel Rodriguez-Saldana


Concordance in goals and interventions between physicians and patients is essential to achieve the expected results of diabetes care; lack of patient adherence and clinical inertia are two main threats. The first one has been recognized since ancient times and for physicians’ convenience has put the blame on patients. Clinical inertia was recently described, but physicians’ resistance, unwillingness, and/or inability to follow clinical practice guidelines or evidence-based recommendations has been described years before receiving its current name. Clinical inertia has been defined as the physicians’ inability to have patients achieve the goals of treatment after repeated medical visits, to initiate or intensify therapy when indicated, and to treat to target or prescribing in disagreement with clinical guidelines, as legitimate efforts to safeguard patients or as the preference to maintain the professional status quo. Clinical inertia has been described in the outpatient and inpatient management of chronic diseases and also in other medical disciplines from dentistry to organ transplantation. Professional characteristics associated with clinical inertia include “soft reasons” (overestimating the benefits of treatment, personal experience, or expertise), reluctance, fallacious reasoning, and professional deficiencies in education and training; structural deficiencies include workload, lack of staff, medications, or equipment. Clinical inertia is also professional reaction for the benefit of patients, based on evidence demonstrating the negative outcomes of aggressive control of diabetes and hypertension. Clinical inertia is more important than deficiencies of patients to comply or adhere to medical recommendations on clinical outcomes, and educational interventions focused on patients have delivered superior results.


Clinical inertia Treatment intensification Clinical guidelines 


  1. 1.
    Pringle M, Stewart-Evans C, Coupland C, Williams I, Allison S, Sterland J. Influences on control in diabetes mellitus: patient, doctor, practice or delivery of care? BMJ. 1993;306:630–4.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Doherty S. History of evidence-based medicine. Oranges, chloride of lime and leeches: Barriers to teaching old dogs new tricks. Emerg Med Australas. 2005;17:314–21.PubMedCrossRefGoogle Scholar
  3. 3.
    Frolkis JP, Zyzanski SJ, Schwartz JM, Suhan PS. Physician Noncompliance with the 1993 National Cholesterol Education Program (NCEP-ATPII) Guidelines. Circulation. 1998;98:851–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Fantini MP, Compagni A, Rucci P, Mimmi S, Longo F. General practitioners’ adherence to evidence-based guidelines: a multilevel analysis. Health Care Manag Rev. 2011;00:1–10.Google Scholar
  5. 5.
    Birrenbach T, Kraehenmann S, Perrig M, Berendonk C, Huwendiek S. Physicians’ attitudes toward, use of, and perceived barriers to clinical guidelines: a survey among Swiss physicians. Adv Med Educ Pract. 2016;7:673–80.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Cook CB, Ziemer DC, El-Kebbi IM, Gallina DL, Dunbar VG, Ernst KL, Phillips LS. Diabetes in Urban African-Americans. XVI. Overcoming clinical inertia improves glycemic control in patients with type 2 diabetes. Diabetes Care. 1999;22:1494–500.PubMedCrossRefGoogle Scholar
  7. 7.
    Phillips LS, Branch WT, Cook CB, Doyle JP, El-Kebbi IM, Gallina DL, Miller CD, Ziemer DC, Barnes CS. Clinical inertia. Ann Intern Med. 2001;135:825–34.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    O’Connor PJ. Overcome clinical inertia to control blood pressure. Arch Intern Med. 2003;163:2677–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Giugliano D, Esposito K. Clinical inertia as a clinical safeguard. JAMA. 2011;305:1591–2.PubMedCrossRefGoogle Scholar
  10. 10.
    Fraenkel L, Cunnigham M, Peters E. Subjective numeracy and preference to stay with the status quo. Med Decis Mak. 2015;35:6–11.CrossRefGoogle Scholar
  11. 11.
    Salisbury C, Fahey T. Overcoming clinical inertia in the management of hypertension. CMAJ. 2006;174:1285–6.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Faria C, Wenzel M, Lee KW, Coderee K, Nichols J, Belletti DA. A narrative review of clinical inertia: focus on hypertension. J Am Soc Hypertens. 2009;3:267–76.PubMedCrossRefGoogle Scholar
  13. 13.
    Viera AJ, Schmid D, Bostrom S, Yow A, Lawrence W, DuBard CA. Level of blood pressure above goal and clinical inertia in a Medicaid population. J Am Soc Hypertens. 2010;4:244–54.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Sanchis-Domenech C, Llisterri-Caro JL, Palomo-Sanz V, Alonso-Moreno FJ, López-Rodríguez I, Nevado-Loro A, et al. Inercia Terapéutica en pacientes hipertensos asistidos en atención primaria en España. Estudio Objetivo Kontrol. Aten Primaria. 2011;
  15. 15.
    Gil-Guillén V, Orozco-Beltrán D, Carratalá-Munuera C, Márquez-Contreras E, Durazo-Arvizu R, Cooper R, et al. Clinical inertia in poorly controlled elderly hypertensive patients: a cross sectional study in Spanish physicians to ascertain reasons for not intensifying treatment. Am J Cardiovasc Drugs. 2013;13:213–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Risso-Gill I, Balabanova D, Majid F, Ng KK, Yussof K, Mustapha F, et al. Understanding the modifiable health systems barriers to hypertension management in Malaysia: a multi-method health systems approach. BMC Health Serv Res. 2015;15:254.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Valle CW, Binns HJ, Quadri-Sheriff M, Benuck I, Patel A. Physicians’ lack of Adherence to National Heart, Lung and Blood Institute Guidelines for Pediatric Lipid Screening. Clin Pediatr. 2015;54:1200–5.CrossRefGoogle Scholar
  18. 18.
    Willig JH, Jackson DA, Westfall AO, Allison J, Chang PW, Raper J, Saag MS, Mugavero MJ. Clinical inertia in the management of low-density lipoprotein abnormalities in an HIV clinic. Clin Infect Dis. 2008;46:1315–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Henke RM, Zaslavsky AM, McGuire TG, Ayanian JZ, Rubenstein LV. Clinical inertia in depression treatment. Med Care. 2009;47:959–67.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Rabenda V, Reginster JY. Prevention and treatment of osteoporosis: avoiding clinical inertia and promoting therapeutic adherence. Rev Med Liege. 2010;65:358–65.PubMedGoogle Scholar
  21. 21.
    Córdoba Cardona J. Hepatic encephalopathy today: how uncertainty perpetuates clinical inertia. Med Clin (Barc). 2009;132:425–7.CrossRefGoogle Scholar
  22. 22.
    Ghosh AK. Care of the elderly: the problem of clinical inertia. Minn Med. 2002;85:6.PubMedGoogle Scholar
  23. 23.
    Suarez AS, Gérard X, Petermans J, Van Hees T. Clinical inertia in geriatrics. Rev Med Liege. 2010;65:256–60.PubMedGoogle Scholar
  24. 24.
    Kiberd J, Panek R, Kiberd B. Strategies to reduce clinical inertia in hypertensive kidney transplant recipients. BMC Nephrol. 2007;27:10.CrossRefGoogle Scholar
  25. 25.
    Moonen ML, Leroux A, Lancellotti P, Piérard LA. Clinical inertia and treatment adherence in the management of chronic valvular heart diseases. Rev Med Liege. 2010;65:290–8.PubMedGoogle Scholar
  26. 26.
    Rindal DB, Rush WA, Boyle RG. Clinical inertia in dentistry: a review of the phenomenon. J Contemp Dent Pract. 2008;9:113–21.PubMedGoogle Scholar
  27. 27.
    Sisó AA. Clinical inertia in osteoarthritis. Aten Primaria. 2012;44:72–3.CrossRefGoogle Scholar
  28. 28.
    Cooke CE, Sidel M, Belletti DA, Fuhlbrigge AL. Review: clinical inertia in the management of chronic obstructive pulmonary disease. COPD. 2012;44:72–3.Google Scholar
  29. 29.
    Wetzler HP, Snyder JW. Linking pharmacy and laboratory data to assess the appropriateness of care in patients with diabetes. Diabetes Care. 2000;23:1637–41.PubMedCrossRefGoogle Scholar
  30. 30.
    Brown JB, Nichols GA. Slow response to loss of glycemic control in type 2 diabetes mellitus. Am J Manag Care. 2003;9:213–7.PubMedGoogle Scholar
  31. 31.
    Brown JB, Nichols GA, Perry A. The burden of treatment failure in type 2 diabetes. Diabetes Care. 2004;27:1535–40.PubMedCrossRefGoogle Scholar
  32. 32.
    Grant RW, Cagliero E, Dubey AK, Gildesgame C, Chueh HC, Barry MJ, Singer DE, Nathan DM, Meigs JB. Clinical inertia in the management of type 2 diabetes metabolic risk factors. Diabet Med. 2004;21:150–5.PubMedCrossRefGoogle Scholar
  33. 33.
    Grant RW, Buse JB, Meigs JB. Quality of diabetes care in U.S. academic medical centers. Diabetes Care. 2005;28:337–42.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Shah BR, Hux JE, Laupacis A, Zinman B, van Walraven C. Clinical inertia in response to inadequate glycemic control. Do specialists differ from primary care physicians? Diabetes Care. 2005;28:600–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Berlowitz DR, Ash AS, Glickman M, Friedman RH, Pogach LM, Nelson AL, Wong AT. Developing a quality measure for clinical inertia in diabetes care. Health Serv Res. 2005;40:1836–53.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Ziemer DC, Miller CD, Rhee MK, Doyle JP, Watkins C, Cook CB, et al. Clinical inertia contributes to poor diabetes control in a primary care setting. Diabetes Educ. 2005;31:564–71.PubMedCrossRefGoogle Scholar
  37. 37.
    Davis TME, Davis WA, Bruce DG. Glycaemic levels triggering intensification of therapy in type 2 diabetes in the community: the Fremantle Diabetes Study. MJA. 2006;184:325–8.PubMedGoogle Scholar
  38. 38.
    Ziemer DC, Doyle JP, Barnes CS, Branch WT, Cook CB, El-Kebbi IM, et al. An intervention to overcome clinical inertia and improve diabetes mellitus control in a primary care setting. Arch Intern Med. 2006;166:507–13.PubMedCrossRefGoogle Scholar
  39. 39.
    Knecht LA, Gautiher SM, Castro JC, Schmidt RE, Whitaker MD, Zimmerman RA, Mishark KJ, Cook CB. Diabetes care in the hospital: is there clinical inertia? J Hosp Med. 2006;1:151–60.PubMedCrossRefGoogle Scholar
  40. 40.
    Rodondi N, Peng T, Karter AJ, Bauer DC, Vittinghoff E, Tang S, et al. Therapy modifications in response to poorly controlled hypertension, dyslipidemia and diabetes mellitus. Ann Intern Med. 2006;144:875–84.CrossRefGoogle Scholar
  41. 41.
    Grant R, Adams AS, Trinacty CM, Zhang F, Kleinman K, Soumeral SB, et al. Relationship between patient medication adherence and subsequent clinical inertia in type 2 diabetes glycemic management. Diabetes Care. 2007;30:807–12.PubMedCrossRefGoogle Scholar
  42. 42.
    Parchman ML, Pugh JA, Romero RL, Bowers KW. Competing demands or clinical inertia: the case of elevated glycosylated hemoglobin. Ann Fam Med. 2007;5:196–201.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Bolen SD, SamuelsTA YH-C, Marinouppoulos SS, McGuire M, Abuid M, Brancati FL. Failure to intensify antihypertensive treatment by primary care providers: a cohort study in adults with diabetes mellitus and hypertension. J Gen Intern Med. 2008;23:543–50.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Giangola J, Olohan K, Longo J, Goldstein JM, Gross PA. Barriers to hyperglycemia control in hospitalized patients: a descriptive epidemiologic study. Endocr Pract. 2008;14:813–9.PubMedCrossRefGoogle Scholar
  45. 45.
    Boord JB, Greevy RA, Braithwaite SS, Arnold PC, Selig PM, Brake H, Cuny J, Baldwin D. Evaluation of glycemic control at US academic medical centers. J Hosp Med. 2009;4:35–44.PubMedCrossRefGoogle Scholar
  46. 46.
    Van Bruggen R, Gorter K, Stolk R, Klungel O, Rutten G. Clinical inertia in general practice: widespread and related to the outcome of diabetes care. Fam Pract. 2009;26:428–36.PubMedCrossRefGoogle Scholar
  47. 47.
    Harris SB, Kapor J, Lank CN, Willan AR, Houston T. Clinical inertia in patients with T2DM requiring insulin in family practice. Can Fam Physician. 2010;56:e418–24.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Zhang Q, Rajagopalan S, Marrett E, Davies MJ, Radican L, Engel SS. Time to treatment initiation with oral antihyperglycaemic therapy in US patients with newly diagnosed type 2 diabetes. Diabetes Obes Metab. 2012;
  49. 49.
    Balkau B, Bouée S, Avignon A, Vergés B, Chartier I, Amelineau E, et al. Type 2 diabetes treatment intensification in general practice in France in 2008-2009: the DIAttitude Study. Diabetes Metab. 2012;38(Suppl 3):S29–35.PubMedCrossRefGoogle Scholar
  50. 50.
    Griffith ML, Boord JB, Eden SK, Matheny ME. Clinical inertia of discharge planning among patients with poorly controlled diabetes mellitus. J Clin Endocrinol Metab. 2012;97:2019–26.PubMedCrossRefGoogle Scholar
  51. 51.
    Marrett E, Zhang Q, Kanitscheider C, Davies MJ, Radican L, Feinglos MN. Physician reasons for non-pharmacologic treatment of hyperglycemia in older patients newly diagnosed with type 2 diabetes mellitus. Diabetes Ther. 2012;3:5.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Ratanawongsa N, Crosson JC, Schillinger D, Karter AJ, Saha CK, Marrero DG. Getting under the skin of clinical inertia in insulin initiation: the Translating Research Into Action for Diabetes (TRIAD) Insulin Starts Project. Diabetes Educ. 2012;38:94–100.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Mata-Cases M, Benito-Badorrey B, Roura-Olmeda P, Franch-Nadal J, Pepió-Villaubi JM, Saez M, et al. Clinical inertia in the treatment of hyperglycemia in type 2 diabetes patients in primary care. Curr Med Res Opin. 2013;29:1495–502.PubMedCrossRefGoogle Scholar
  54. 54.
    Khunti K, Wolden ML, Thorsted BL, Andersen M, Davies MJ. Clinical inertia in people with type 2 diabetes: a retrospective cohort study of more than 80,000 people. Diabetes Care. 2013;36:3411–7.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Strain WD, Cos X, Hirst M, Vencio S, Mohan V, Vokó Z, et al. Time to do more: addressing clinical inertia in the management of type 2 diabetes mellitus. Diabetes Res Clin Pract. 2014;105:302–12.PubMedCrossRefGoogle Scholar
  56. 56.
    Whitford DL, Al-Anjawi HA, Al-Baharna MM. Impact of clinical inertia on cardiovascular risk factors in patients with diabetes. Prim Care Diabetes. 2014;8:133–8.PubMedCrossRefGoogle Scholar
  57. 57.
    González-Clemente JM, Font B, Lahoz R, Llauradó G, Gambús G. 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;142:478–84.CrossRefGoogle Scholar
  58. 58.
    Zafar A, Stone MA, Davies MJ, Khunti K. Acknowledging and allocating responsibility for clinical inertia in the management of type 2 diabetes in primary care: a qualitative study. Diabet Med. 2015;32:407–13.PubMedCrossRefGoogle Scholar
  59. 59.
    Bralic-Lang V, Bergman Markovic B, Kranjcevic K. Family physician clinical inertia in glycemic control among patients with type 2 diabetes. Med Sci Monit. 2015;21:403–11.PubMedCrossRefGoogle Scholar
  60. 60.
    Lin J, Zhou S, Wei W, Pan C, Lingohr-Smith M, Levin P. Does clinical inertia vary by personalised A1c goal? A study of predictors and prevalence of clinical inertia in a US managed care setting. Endocr Pract. 2016;22:151–61.PubMedCrossRefGoogle Scholar
  61. 61.
    Khunti K, Nikolajsen A, Thorsted BL, Andersen M, Davies MJ, Paul SK. Clinical inertia with regard to intensifying therapy in people with type 2 diabetes treated with basal insulin. Diabetes Obes Metab. 2016;18:401–9.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Kekäläinen P, Tirkkonen H, Laatikainen T. How are metabolic control targets of patients with Type 1 Diabetes mellitus achieved in daily practice in the area with high diabetes prevalence? Diabetes Res Clin Pract. 2016;115:9–16.PubMedCrossRefGoogle Scholar
  63. 63.
    Osataphan S, Chalermchai T, Ngaosuwan K. Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: a retrospective cohort study. J Diabetes. 2016;
  64. 64.
    Goderis G, Vaes B, Van den Akker M, Elli S, Mathieu C, Buntinx F, Henrard S. Factors associated with Prolonged Inaction in the hypoglycaemic treatment in people with non-insulin dependent Type 2 Diabetes and elevated glycated haemoglobin: A registry-based cohort study. Prim Care Diabetes. 2017;11:193–8.CrossRefGoogle Scholar
  65. 65.
    Blonde L, Raccah D, Lew E, Meyers J, Nikonova E, Ajmera M, et al. Treatment intensification in type 2 diabetes: a real-World Study of 2-OAD Regimens, GLP-1, RAs, or Basal Insulin. Diabetes Ther. 2018;9:1169–84.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Pantalone KM, Misra-Hebert AD, Hobbs TM, Ji X, Kong SX, Milinovich A. Clinical inertia in type 2 diabetes management: evidence from a large, real-world data set. Diabetes Care. 2018;41:e113–4.PubMedCrossRefGoogle Scholar
  67. 67.
    Harle CA, Harman JS, Yang S. Physician and patient characteristics associated with clinical inertia in blood pressure control. J Clin Hypertens. 2013;15:820–4.CrossRefGoogle Scholar
  68. 68.
    Khunti K, Davies MJ. Clinical inertia versus overtreatment in glycaemic management. Lancet Diabetes Endocrinol. 2018;6:266–8.PubMedCrossRefGoogle Scholar
  69. 69.
    Vigersky RA, Fitzner K, Levinson J. Barriers and potential solutions to providing optimal guideline-driven care to patients with diabetes in the U.S. Diabetes Care. 2013;36:3843–9.PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Pimazoni-Netto A, Zanella MT. Diabetes guidelines may delay timely adjustments during treatment and might contribute to clinical inertia. Diabetes Technol Ther. 2014;16:768–70.PubMedPubMedCentralCrossRefGoogle Scholar
  71. 71.
    Qaseem A, Wilt TJ, Kansagara D, Horwitch C, Barry MJ, Forciea MA. 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. 2018;168:569. 6 March 2018.CrossRefPubMedGoogle Scholar
  72. 72.
    Morales J, Assumpcao-Morales M. The 2018 update of the American College of Physicians glycemic management recommendations – an invitation to continued inertia? Diabet Med. 2018;20:1809. Scholar
  73. 73.
    Home P. Diabetes: a diabetes mellitus guideline gone wrong – the 2017 ACP update. Nat Rev Endocrinol. 2017;13:191–2.PubMedCrossRefGoogle Scholar
  74. 74.
    Esposito K, Ceriello A, Giugliano D. Does personalized diabetology overcome clinical uncertainty and therapeutic inertia in Type 2 diabetes? Endocrine. 2013;44:343–5.PubMedCrossRefGoogle Scholar
  75. 75.
    Conlin PR, Colburn J, Aron D, Pries RM, Tschanz MP, Pogach L. Synopsis of the 2017 U.S. department of veterans affairs/U.S. department of defense clinical practice guideline: management of type 2 diabetes mellitus. Ann Intern Med. 2017;167:655–63.PubMedCrossRefGoogle Scholar
  76. 76.
    Pallarés-Carratalá V, Pérez RP. Non-compliance and therapeutic inertia: two unanswered questions in clinical practice. Curr Med Res Opin. 2014;30:839–40.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Schmittdel JA, Uratsu CS, Karter AJ, Heisler M, Subramanian U, Mangione CM, et al. Why don’t patients achieve recommended risk factor targets? poor adherence versus lack of treatment intensification. J Gen Intern Med. 2008;23:588–94.CrossRefGoogle Scholar
  78. 78.
    Roumie CL, Elasy TA, Greevy R, Griffin MR, Liu X, Stone WJ, et al. Improving blood pressure control through provider education, provider alerts and patient education: a cluster randomized trial. Ann Intern Med. 2006;145:165–75.PubMedCrossRefGoogle Scholar
  79. 79.
    Guthrie B, Inkster M, Fahey T. Tackling therapeutic inertia: role of treatment data in quality indicators. BMJ. 2007;335:542–4.PubMedPubMedCentralCrossRefGoogle Scholar
  80. 80.
    O’Connor PJ. Commentary – improving diabetes care by combating clinical inertia. Health Serv Res. 2005;40:1854–61.PubMedPubMedCentralCrossRefGoogle Scholar
  81. 81.
    Reach G, Pechtner V, Gentilella R, Corcos A, Ceriello A. Clinical inertia and its impact on treatment intensification in people with type 2 diabetes mellitus. Diabetes Metab. 2017;43:501–11.PubMedCrossRefGoogle Scholar
  82. 82.
    O’Connor PJ, Sperl-Hillen JAM, Johnson PE, Rush WA, Biltz G. Clinical inertia and inpatient medical errors. In: Henriksen K, Battles JB, Marks ES, Lewin DI, editors. Advances in patient safety: from research to implementation (Volume 2: concepts and methodology). Rockville: Agency for Healthcare Research and Quality (US); 2005.Google Scholar
  83. 83.
    Perlin JB, Pogach LM. Improving the outcomes of metabolic conditions: managing momentum to overcome clinical inertia. Ann Intern Med. 2006;144:525–7.PubMedCrossRefGoogle Scholar
  84. 84.
    Strain WD, Blüher M, Paldánius P. Clinical inertia in individualising care for diabetes: is there time to do more in type 2 diabetes? Diabetes Ther. 2014;5:347–54.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Paling J. Strategies to help patients understand risks. BMJ. 2003;327:745–8.PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Bailey CJ. Under-treatment of type 2 diabetes: causes and outcomes of clinical inertia. Int J Clin Pact. 2016;70:988–95.CrossRefGoogle Scholar
  87. 87.
    Reach G. Clinical inertia, uncertainty and individualized guidelines. Diabetes Metab. 2014;40:241–5.PubMedCrossRefGoogle Scholar
  88. 88.
    Barth JH, Misra S, Aakre KM, Langlois MR, Watine J, Twomey PJ, et al. Why are clinical practice guidelines not followed? Clin Chem Lab Med. 2015;
  89. 89.
    Reach G. Patient non-adherence and healthcare-provider inertia are clinical myopia. Diabetes Metab. 2008;34:382–5.PubMedCrossRefGoogle Scholar
  90. 90.
    Reach G. Clinical inertia, uncertainty and individual guidelines. Diabetes Metab. 2014;40:241–5.PubMedCrossRefGoogle Scholar
  91. 91.
    Miles RW. Fallacious reasoning and complexity as root causes of clinical inertia. J Am Med Dir Assoc. 2007;8:349–54.PubMedCrossRefGoogle Scholar
  92. 92.
    Miles RW. Cognitive bias and planning error: nullification of evidence-base medicine in the nursing home. J Am Dir Assoc. 2010;11:194–203.CrossRefGoogle Scholar
  93. 93.
    Safford MM, Shewchuck R, Qu H, Williams JH, Estrada CA, Ovalle F, et al. Reasons for not intensifying medications: differentiating “clinical inertia” from appropriate care. J Gen Intern Med. 2007;22:1648.PubMedPubMedCentralCrossRefGoogle Scholar
  94. 94.
    Aujoulat I, Jacquemin P, Rietzschel E, Scheen A, Tréfois P, Wens J, et al. Factors associated with clinical inertia: an integrative review. Adv Med Educ Pract. 2014;4:141–7.CrossRefGoogle Scholar
  95. 95.
    Khunti K, Millar-Jones D. Clinical inertia to insulin initiation and intensification in the UK: a focused literature review. Prim Care Diabetes. 2017;11:3–12.PubMedCrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Joel Rodriguez-Saldana
    • 1
  1. 1.Multidisciplinary Centre of DiabetesMexico CityMexico

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