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Clinical inertia, reverse clinical inertia, and medication non-adherence in type 2 diabetes

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Abstract

Purpose

Clinical inertia and medication non-adherence are thought to contribute largely to the suboptimal glycemic control in many patients with type 2 diabetes. The present review explores the relations between A1C targets, clinical inertia and medication non-adherence in type 2 diabetes.

Methods

We searched PubMed for English-language studies published from 2001 through June 1, 2018. We also manually searched the references of selected articles, reviews, meta-analyses, and practice guidelines. Selected articles were mutually agreed upon by the authors.

Results

Clinical inertia is the failure of clinicians to initiate or intensify therapy when indicated, while medication non-adherence is the failure of patients to start or continue therapy that a clinician has recommended. Although clinical inertia may occur at all stages of diabetes treatment, the longest delays were reported for initiation or intensification of insulin. Medication non-adherence to antidiabetic drugs may range from 53 to 65% at 1 year and may be responsible for uncontrolled A1C in about 23% of cases. Reverse clinical inertia can be acknowledged as the failure to reduce or change therapy when no longer needed or indicated. Clinical inertia and medication non-adherence are difficult to address: clinician-and patient-targeted educational programs, more connected communications between clinicians and patients, the help of other health professional figures (nurse, pharmacist) have been explored with mixed results.

Conclusions

Both clinical inertia and medication non-adherence remain significant barriers to optimal glycemic targets in type 2 diabetes. Moreover, part of clinical inertia may be a way through which clinicians face current uncertainty in medicine, including some dissonance among therapeutic guidelines. Scientific associations should find an agreement about how to measure and report clinical inertia in clinical practice and should exhort clinicians to consider reverse clinical inertia as a cause of persisting inappropriate therapy in vulnerable patients.

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Funding

The present research was supported in part by the Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, and the “Associazione Salute con Stile”, Naples, Italy.

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Authors and Affiliations

  1. Division of Endocrinology and Metabolic Diseases, Università della Campania L. Vanvitelli, Piazza L. Miraglia, 2, 80138, Naples, Italy

    D. Giugliano & G. Bellastella

  2. Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Università della Campania L. Vanvitelli, Naples, Italy

    M. I. Maiorino & K. Esposito

Authors
  1. D. Giugliano
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  2. M. I. Maiorino
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  3. G. Bellastella
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  4. K. Esposito
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All authors contributed equally to this review.

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Correspondence to D. Giugliano.

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Conflict of interest

D.G. received honoraria for speaking at meetings from Novartis, Sanofi-Aventis, Lilly, AstraZeneca. M.I.M. received honoraria for speaking at meetings from Astra-Zeneca, Sanofi-Aventis. G.B.declared no conflict of interest. K.E. received honoraria for speaking at meetings from Novartis, Sanofi-Aventis, Lilly, AstraZeneca, Boehringer Ingelheim.

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Giugliano, D., Maiorino, M.I., Bellastella, G. et al. Clinical inertia, reverse clinical inertia, and medication non-adherence in type 2 diabetes. J Endocrinol Invest 42, 495–503 (2019). https://doi.org/10.1007/s40618-018-0951-8

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