title: Under-treatment of type 2 diabetes: Causes and outcomes of clinical inertia.
abstract: OBJECTIVE
  To assess the impact of clinical inertia on type 2 diabetes (T2D) care.
  
  
  METHODS
  PubMed database search from January 2000 until December 2015.
  
  
  RESULTS
  Clinical inertia, defined as resistance to initiate or intensify treatment in a patient not at the evidence-based glycated haemoglobin goal, is conservatively estimated to occur in at least 25% of patients with T2D. Consequently, many patients with diagnosed and treated T2D experience extended periods, in some cases years, of ineffectively controlled hyperglycaemia, potentially causing serious microvascular and macrovascular harm. Delayed treatment does not appear to be specific to primary care, but also occurs in the specialist setting. The causes of clinical inertia appear to be complex, involving both reasonable and unacceptable delays on the part of the clinician and poor compliance with treatment regimens on the part of the patient. Evidence suggests that the clinical and organisational context may be particularly important in reinforcing clinical inertia, notably the increasingly severe time constraints for diagnosis and management of multiple morbidities, consideration of complex guidelines, assessment of cost and appreciation of patient concerns, all of which may hamper prioritisation of the important issue of under-treatment.
  
  
  CONCLUSIONS
  Since the pharmacotherapeutic tools for good control of blood glucose exist in all advanced healthcare systems, initiatives to address the important and widespread problem of clinical inertia may require focused campaigns that encourage attention to guideline recommendations and their adaptation for individualised care.
authors.affiliation: Diabetes Research, Life and Health Sciences, Aston University, Birmingham, UK.
authors.forename: Clifford J
authors.initials: CJ
authors.lastname: Bailey
mesh_terms: D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D019468:Disease Management; D006442:Glycated Hemoglobin / Q000627:therapeutic use; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D058007:Physicians, Primary Care; D011320:Primary Health Care / Q000458:organization & administration*; D012941:Social Responsibility
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents