‘Clinical Inertia’ Hampers Diabetes Management

2006 ◽  
Vol 39 (13) ◽  
pp. 12
Author(s):  
MIRIAM E. TUCKER
Keyword(s):  
Diabetes Management ◽  
Clinical Inertia

scholarly journals Benefit of Digital Tools Used for Integrated Personalized Diabetes Management: Results From the PDM-ProValue Study Program

2019 ◽  
Vol 14 (2) ◽  
pp. 240-249
Author(s):  
Lutz Heinemann ◽  
Wendelin Schramm ◽  
Helena Koenig ◽  
Annette Moritz ◽  
Iris Vesper ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Diabetes Management ◽  
Intervention Group ◽  
Digital Tools ◽  
Clinical Inertia ◽  
Control Group ◽  
Traffic Light ◽  
Study Program ◽  
Therapeutic Concept ◽  
Cluster Randomized

Background: Integrated personalized diabetes management (iPDM) is a digitally supported therapeutic concept to improve patient-physician interaction to overcome the aspects of clinical inertia. Integrated personalized diabetes management can support decision making and improve therapeutic outcomes of suboptimally controlled persons with insulin-treated type 2 diabetes (T2D). In this paper, we report the results of an analysis of the PDM-ProValue study program on the effectiveness and perceived benefit of this approach, with a focus on how physicians used and assessed the digital tools provided for the iPDM process. Materials and Methods: The study program included two 12-month, prospective, controlled, cluster-randomized multicenter trials. A total of 101 practices participated with 907 patients. Practices were cluster-randomized to an intervention group and a control group. Digital tools for data visualization and analysis applied were used. HCP were asked to assess the use, relevance, and usefulness of the tools. Results: A clear preference was stated for the visual overview over more statistically complex analyses. A total of 83% of the participants rated a high relevance of the “daily profile,” 81% of the “total profile,” and 68% the “risk illustrated by traffic light symbols” for the therapy decision. The overall iPDM process was very favorably rated with respect to structuredness and potential for personalized treatment and well accepted among health care professionals (HCP). Conclusions: Embedding digital tools in a structured process (iPDM) were proved to provide a benefit for insulin-treated T2D patients and their physicians. These results offer insight for further development and improvement of the tools and add information on how to overcome clinical inertia.

scholarly journals Determinants of good metabolic control without weight gain in type 2 diabetes management: a machine learning analysis

2020 ◽  
Vol 8 (1) ◽  
pp. e001362
Author(s):  
Carlo Bruno Giorda ◽  
Federico Pisani ◽  
Alberto De Micheli ◽  
Paola Ponzani ◽  
Giuseppina Russo ◽  
...  
Keyword(s):  
Machine Learning ◽  
Type 2 Diabetes ◽  
Weight Gain ◽  
Metabolic Control ◽  
Diabetes Management ◽  
Microvascular Complications ◽  
Clinical Inertia ◽  
Oral Agents

IntroductionThe aim of this study was to investigate the factors (clinical, organizational or doctor-related) involved in a timely and effective achievement of metabolic control, with no weight gain, in type 2 diabetes.Research design and MethodsOverall, 5.5 million of Hab1c and corresponding weight were studied in the Associazione Medici Diabetologi Annals database (2005–2017 data from 1.5 million patients of the Italian diabetes clinics network). Logic learning machine, a specific type of machine learning technique, was used to extract and rank the most relevant variables and to create the best model underlying the achievement of HbA1c<7 and no weight gain.ResultsThe combined goal was achieved in 37.5% of measurements. High HbA1c and fasting glucose values and slow drop of HbA1c have the greatest relevance and emerge as first, main, obstacles the doctor has to overcome. However, as a second line of negative factors, markers of insulin resistance, microvascular complications, years of observation and proxy of duration of disease appear to be important determinants. Quality of assistance provided by the clinic plays a positive role. Almost all the available oral agents are effective whereas insulin use shows positive impact on glucometabolism but negative on weight containment. We also tried to analyze the contribution of each component of the combined endpoint; we found that weight gain was less frequently the reason for not reaching the endpoint and that HbA1c and weight have different determinants. Of note, use of glucagon-like peptide-1 receptor agonists (GLP1-RA) and glifozins improves weight control.ConclusionsTreating diabetes as early as possible with the best quality of care, before beta-cell deterioration and microvascular complications occurrence, make it easier to compensate patients. This message is a warning against clinical inertia. All medications play a role in goal achievements but use of GLP1-RAs and glifozins contributes to overweight prevention.

scholarly journals Association between Systolic Blood Pressure and Diabetic Retinopathy in Both Hypertensive and Normotensive Patients with Type 2 Diabetes: Risk Factors and Healthcare Implications

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 580
Author(s):  
Yu-Ting Li ◽  
Yi Wang ◽  
Xiu-Jing Hu ◽  
Jia-Heng Chen ◽  
Yun-Yi Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Diabetes Management ◽  
Clinical Laboratory ◽  
Clinical Inertia ◽  
Diabetic Patients ◽  
Haemoglobin A1c ◽  
Ordinal Logistic Regression Analysis

A common diabetes-related microvascular complication is diabetic retinopathy (DR), yet associations between blood pressure (BP) and risks for DR in diabetic patients with normal BP received inadequate attention. This may lead to ‘clinical inertia’ in early DR prevention. We aimed to assess whether the extent to which systolic BP levels were associated with DR in patients with type 2 diabetes (T2DM) and normal BP were similar to that in those with concurrent hypertension. Data were collected from patients with T2DM attending ophthalmic check-up with primary care referral (n = 2510). BP measurements, clinical laboratory tests, and dilated fundus examination were conducted according to gold standard of diagnosis and routine clinical procedure. Of all subjects, over 40% were normotensive and one fifth were clinically diagnosed with DR. Systolic BP levels increased across DR categories of escalated severity irrespective of the coexistence of hypertension. Ordinal logistic regression analysis showed that an increased systolic BP was independently and significantly associated with DR (adjusted odds ratio [aOR] = 1.020, p < 0.001 for hypertensives; aOR = 1.019, p = 0.018 for normotensives), after adjusting for diabetes duration, sex, lifestyles, and haemoglobin A1c levels. Regular monitoring of systolic BP should not be neglected in routine diabetes management even when BP falls within the normal range. (200 words)

scholarly journals Clinical inertia in type 2 diabetes management in a middle-income country: A retrospective cohort study

PLoS ONE ◽  
2020 ◽  
Vol 15 (10) ◽  
pp. e0240531
Author(s):  
Kim Sui Wan ◽  
Foong Ming Moy ◽  
Khalijah Mohd Yusof ◽  
Feisul Idzwan Mustapha ◽  
Zainudin Mohd Ali ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Diabetes Management ◽  
Middle Income Country ◽  
Income Country ◽  
Clinical Inertia ◽  
Middle Income

Clinical Inertia Contributes to Poor Diabetes Control in a Primary Care Setting

2005 ◽  
Vol 31 (4) ◽  
pp. 564-571 ◽  
Author(s):  
David C. Ziemer ◽  
Christopher D. Miller ◽  
Mary K. Rhee ◽  
Joyce P. Doyle ◽  
Clyde Watkins ◽  
...  
Keyword(s):  
Primary Care ◽  
African American ◽  
Glycemic Control ◽  
Diabetes Management ◽  
Clinical Inertia ◽  
Medical Clinic ◽  
Diabetes Clinic ◽  
General Internal ◽  
Glucose Levels ◽  
Primary Care Site

Purpose The purpose of this study was to determine whether “clinical inertia”—inadequate intensification of therapy by the provider—could contribute to high A1C levels in patients with type 2 diabetes managed in a primary care site. Methods In a prospective observational study, management was compared in the Medical Clinic, a primary care site supervised by general internal medicine faculty, and the Diabetes Clinic, a specialty site supervised by endocrinologists. These municipal hospital clinics serve a common population that is largely African American, poor, and uninsured. Results Four hundred thirty-eight African American patients in the Medical Clinic and 2157 in the Diabetes Clinic were similar in average age, diabetes duration, body mass index, and gender, but A1C averaged 8.6% in the Medical Clinic versus 7.7% in the Diabetes Clinic (P < .0001). Use of pharmacotherapy was less intensive in the Medical Clinic (less use of insulin), and when patients had elevated glucose levels during clinic visits, therapy was less than half as likely to be advanced in the Medical Clinic compared to the Diabetes Clinic (P < .0001). Intensification rates were lower in the Medical Clinic regardless of type of therapy (P < .0001), and intensification of therapy was independently associated with improvement in A1C (P < .001). Conclusions Medical Clinic patients had worse glycemic control, were less likely to be treated with insulin, and were less likely to have their therapy intensified if glucose levels were elevated. To improve diabetes management and glycemic control nationwide, physicians in training and generalists must learn to overcome clinical inertia, to intensify therapy when appropriate, and to use insulin when clinically indicated.

scholarly journals Clinical Inertia in Type 2 Diabetes Management: Evidence From a Large, Real-World Data Set

Diabetes Care ◽  
2018 ◽  
Vol 41 (7) ◽  
pp. e113-e114 ◽  
Author(s):  
Kevin M. Pantalone ◽  
Anita D. Misra-Hebert ◽  
Todd M. Hobbs ◽  
Xinge Ji ◽  
Sheldon X. Kong ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Real World ◽  
Diabetes Management ◽  
Clinical Inertia ◽  
Real World Data ◽  
Data Set ◽  
World Data

scholarly journals Pathophysiologic Approach to Type 2 Diabetes Management: One Centre Experience 1980–2020

2021 ◽  
Author(s):  
Rudolf Chlup ◽  
Richard Kaňa ◽  
Lada Hanáčková ◽  
Hana Zálešáková ◽  
Blanka Doubravová
Keyword(s):  
Diabetes Management ◽  
Case Reports ◽  
Sglt2 Inhibitor ◽  
Diabetes Type 2 ◽  
Clinical Inertia ◽  
Insulin Analogs ◽  
Receptor Agonists ◽  
Multiple Doses ◽  
Insulin Pens

This overview summarizes the evolution of pathophysiologic treatment of diabetes type 2 (T2D) in the period of the last 40 years. Randomized Controlled Trials (RCT) and Real World Evidence (RWE) studies resulted in recent Statements of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) in the year 2020. Case reports and studies of a single-centre in Czech Republic are reported. The authors demonstrate the impact of (1) multiple doses of rapid insulin, (2) multiple doses of rapid or ultrarapid insulin analogs (3) continuous subcutaneous insulin infusion (CSII) (4) incretin receptor agonists, (5) fixed combination of insulin degludec with liraglutide (IDegLira) and (6) SGLT2 inhibitor dapagliflozin, on plasma glucose concentration, HbA1c, body mass and patient satisfaction. The importance of therapeutic patients´ education and technology (personal glucometers, continuous/flash glucose monitors, insulin pens/pumps) is emphasized. Most of the observations were already published. Hence, individually adopted education, lifstyle, technical equipment, incretin receptor agonists and/or metformin and/or gliflozins and/or insulin analogs appear to be the core of an effective pathophysiologic approach. Scientific conclusions from RCTs, RWE trials and own clinical case reports may prevail over clinical inertia and induce early implementation of effective methods into routine T2D treatment.

130 Impact of Low-Dose High-Frequency in situ Simulation on Inpatient Diabetes Management: A Pilot Study

2021 ◽  
Author(s):  
Sree Kumar EJ ◽  
Makani Purva
Keyword(s):  
High Frequency ◽  
Low Dose ◽  
Diabetes Management ◽  
Working Hours ◽  
Clinical Inertia ◽  
P Value ◽  
Biomedical Knowledge ◽  
Patients With Diabetes ◽  
Control Of Diabetes ◽  
Inpatient Diabetes Management

Even in the presence of established institutional guidelines, failure of compliance by the clinical teams plays an important role in the control of diabetes. The identified gaps include contextual and biomedical knowledge, attitudes, clinical inertia, confidence and familiarity with existing hospital resources and guidelines with regards to hospital diabetes care We wanted to demonstrate the efficacy of low-dose high-frequency The exercise was a 15-minute session, delivered during working hours to individual nurses. This consisted of a 5-minute scenario, involving a standardized patient followed by a 10-minute debrief. Modified Diamond-model debrief with an advocacy-inquiry model was used by the debriefer, a trained fellow in simulation, and overseen by an expert. The scripted scenario involved a patient with Diabetic Ketoacidosis (DKA), with learning outcomes of recognizing DKA, managing the patient and adhering to the institutional guidelines including management of hypoglycaemia. The scenario was individualized based on the roles of the participants. Pre- and post-questionnaires were given to the participants. The simulation was repeated twice in the second week and once in the third week.This mixed-method study was conducted in a UK teaching hospital, in a ward designated for patients with diabetes, as a part of a quality improvement programme. In the first week, patients with diabetes, admitted for DKA, were chosen and their blood sugar recordings, dysglycaemic episodes and adherence to guidelines were noted. Every week data were collected as in the first week. GNU pspp 1.0.1 [version 3] free software was used. The confidence scores were given as mean and standard deviation with confidence interval (CI) of 98.75%. A p-value of <0.0125 was considered significant based on the number of data points.The Dysglycemic episodes and protocol adherence from medical recordsConsidering the T2 (increased recognition of diabetic emergencies and adherence to protocol) and T3 (improved patient outcomes) outcomes, the methodology was recommended as a modality of training the nursing staff involved in inpatient care of patients with diabetes. Future programmes including multi-disciplinary teams, to explore teamwork and communication, are planned.

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