title: Time to do more: addressing clinical inertia in the management of type 2 diabetes mellitus.
abstract: OBJECTIVE
  Clinical inertia, the tendency to maintain current treatment strategies despite results demanding escalation, is thought to substantially contribute to the disconnect between clinical aspirations for patients with diabetes and targets achieved. We wished to explore potential causes of clinical inertia among physicians and people with diabetes.
  
  
  METHODS
  A 20-min online survey of 652 adults with diabetes and 337 treating physicians in six countries explored opinions relating to clinical inertia from both perspectives, in order to correlate perceptions and expectations relating to diagnosis, treatment, diabetes complications and therapeutic escalation.
  
  
  RESULTS
  Physicians had low expectations for their patients, despite the belief that the importance of good glycaemic control through lifestyle and pharmacological interventions had been adequately conveyed. Conversely, people with diabetes had, at best, a rudimentary understanding of the risks of complications and the importance of good control; indeed, only a small proportion believed lifestyle changes were important and the majority did not intend to comply.
  
  
  CONCLUSIONS
  The principal findings of this survey suggest that impairments in communication are at the heart of clinical inertia. This manuscript lays out four key principles that we believe are achievable in all environments and can improve the lives of people with diabetes.
authors: Diabetes and Vascular Research Centre, University of Exeter Medical School, Barrack Road, Exeter EX25AX, UK. Electronic address: d.strain@exeter.ac.uk.
authors: W D
authors: WD
authors: Strain
authors: Sant Marti de Provençals Primary Health Care Centre, Institut Català de la Salut, Generalitat de Catalunya, C/ Fluvià 211, 08020 Barcelona, Spain.
authors: X
authors: X
authors: Cos
authors: International Diabetes Federation, Glentirran House, Kippen, Stirlingshire FK8 3DY, Scotland, UK.
authors: M
authors: M
authors: Hirst
authors: Catholic University of Goiás, Goiânia, Avenida T4 number 313, Setor Bueno, Goiania CEP 74230-030, Brazil.
authors: S
authors: S
authors: Vencio
authors: Dr. Mohan's Diabetes Specialities Centre, Madras Diabetes Research Foundation, Conran Smith Road, Gopalapuram, Chennai 600086, India.
authors: V
authors: V
authors: Mohan
authors: Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Syreon Research Institute, Thökölly út 119, 1146 Budapest, Hungary.
authors: Z
authors: Z
authors: Vokó
authors: Center for Diabetes, Endocrinology and Metabolism and Center for Metabolism and Clinical Nutrition, Kansai Electric Power Hospital, 2-1-7 Fukushima-ku, Osaka 553-0003, Japan.
authors: D
authors: D
authors: Yabe
authors: University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
authors: M
authors: M
authors: Blüher
authors: Novartis Pharma AG, Postfach CH-4002, Basel, Switzerland.
authors: P M
authors: PM
authors: Paldánius
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003625:Data Collection; D048909:Diabetes Complications / Q000517:prevention & control* / Q000523:psychology* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D058015:Health Communication / Q000379:methods*; D006801:Humans; D007003:Hypoglycemia / Q000150:complications; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D010349:Patient Compliance; D016896:Treatment Outcome
keywords: Clinical inertia; Hypoglycaemia; Type 2 diabetes