Clinical inertia to insulin initiation and intensification in the UK: A focused literature review. Issue 1 (February 2017)

• Record Type: Journal Article
• Authors: Khunti, Kamlesh; Millar-Jones, David
• Is Part Of: Primary care diabetes. Volume 11:Issue 1(2017)
• Page Start: 3
• Page End: 12
• Publication Date: 2017-02
• Subjects: Insulin intensification -- Clinical inertia -- Type 2 diabetes guidelines; Diabetes -- Periodicals; 616.462
• DOI: 10.1016/j.pcd.2016.09.003
• Languages: English
• ISSNs: 1751-9918

Abstract

Highlights: Timely achievement of glycaemic control is key to optimising clinical outcomes. Clinical inertia is most pronounced at the intensification with insulin stage. The NICE guidelines on type 2 diabetes do not explicitly address clinical inertia. Barriers to treatment intensification span patient, clinician and system levels. Clinical inertia can be tackled with increased education on therapeutic options. Abstract: Achieving tight glycaemic control early following the diagnosis of type 2 diabetes is key to optimising clinical outcomes, yet many patients and clinicians are reluctant to initiate and intensify insulin therapy. Reasons for this arise primarily from a lack of time, clinical expertise and patient understanding. However, meaningful progress can be achieved with self-management educational programmes soon after diagnosis. Clinician education and training, along with easy-to-use and well-tolerated therapies (for example, those carrying a low risk of hypoglycaemia and/or avoiding weight gain), may also increase the likelihood of patient adherence.