“What Happened?” Exploring the Complexities of Clinical Inertia in the Treatment of People with Type 2 Diabetes

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Presentation: 4:48


The diabetes epidemic in the US affects over 29 million individuals every day. Type 2 diabetes accounts for 95% of those cases. Each year approximately $245 billion is spent on caring for individuals with diabetes. Yet, 33-49% of patients with diabetes do not meet the target for glycemic control. There are many reasons that can be cited as to the cause for the lack of glycemic control in almost half of patients with diabetes however one possible explanation is the phenomenon of clinical inertia. Clinical inertia in the treatment of type 2 diabetes is the failure of a healthcare provider to escalate pharmacotherapy when glycemic control (HbA1c <7.0%) is not achieved. The purpose of this study is to identify and describe the signs during a clinical encounter that can lead to clinical inertia. An observational retrospective electronic medical record review was conducted on 18 patients. The medical visits related to diabetes care was transcribed and analyzed to determine if appropriate diabetes care was rendered or clinical inertia occurred. Of the 18 patients reviewed, appropriate diabetes care was found in 10 patients and clinical inertia was found to be present in 8 patients. Four types of clinical inertia was found: 1 case was due to competing demands, 2 cases were due to the presence of an endocrinology specialist, 2 cases were a result of “interrupted” clinical inertia, and 3 cases were true examples of clinical inertia. Clinical inertia is a very complicated phenomenon. Why a provider may or may not escalate pharmacotherapy in a patient with diabetes is difficult to determine. However, clinical inertia is a plausible explanation for the delay in escalation in treatment that can lead to long-term micro- and macro-vascular complications in patients with type 2 diabetes.