Recent perspectives for clinical inertia for diabetes mellitus

Abstract

Diabetes mellitus (DM) has been a chronic disease with high social, medical, economic, and health burdens. Across the world, type 2 DM (T2DM) patients were observed at 425 million in 2017 and will be 629 million in 2045 [1]. The main concern would be a rapidly growing number, related complications and adequate treatment in response to various situations [2]. Clinical inertia or therapeutic inertia was defined as the failure to intensify or initiate adequate treatment in accordance with evidence-based guidelines. It is often a key cause for persisting hyperglycemia in T2DM patients [3,4]. Diabetic inertia occurs when healthcare professionals recognize the clinical situation for uncontrolled glucose variability, but do not conduct proper treatment The recent consensus of the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) has been presented, indicating to evaluate and to modify the treatment regularly at the 3-6-month interval, when HbA1c values remain above the target level [6]. International Diabetes Federation (IDF), ADA, and Japanese Clinical Practice Guidelines (JCPG) have presented the recommendation of HbA1c level as <7.0% for the majority of T2DM adults [7-9]. On the other hand, the American Association of Clinical Endocrinologists (AACE) has supported a slightly strict HbA1c level of <6.5% for most diabetic patients [10]. ADA and JCPG recommend rather stringent goals <6.5% and <6.0% for selected patients if achievable without the history of significant hypoglycemia or other adverse effects [7,8]. However, when the case has found severe hypoglycemia, advanced cardiovascular or extensive complications, the goal will be the less stringent level of <8.0%