Archive | 2019
Clinical inertia on insulin treatment in the primary care setting
Abstract
The prevention and treatment of type 2 diabetes (DM2) has become one of the main challenges for health institutions. Global prevalence of this condition has increased from 4.7 % in 1980 to 8.5 % in 2014.1 In Europe, the prevalence of diabetes has been estimated to be 7.8%; in North America and the Caribbean it is 11.4%, and in South America, 8.1%.2 In Mexico, the results of the half-way 2016 National Health and Nutrition Survey (ENSANUT – Encuesta Nacional de Salud y Nutrición) showed that the prevalence of known diabetes cases was 9.2 %.3 This survey also reported that only 25.3 % of patients reached the glycosylated hemoglobin (HbA1c) therapeutic goals of < 7 % and only 13 % of those receiving medical care were treated with insulin for the control of hyperglycemia.4 Numerous patients with diabetes initially treated with diet, exercise or medication will eventually require treatment intensification.5 However, it has been demonstrated that this therapeutic measure can be delayed for several years, particularly when insulin is the next treatment option.6 Different studies have focused on patients’ “psychological insulin resistance”, a term that refers to their refusal to accept insulin treatment due to negative expectations about the results;7,8 however, few evaluate physicians’ rejection to prescribe insulin.9 This phenomenon –known as “clinical inertia”– is characterized by the inability of the physician to intensify treatment in a timely manner, a delay that is one of the most important factors that hinder adequate and quality care for patients with DM2 (i.e., correcting poor glycemic control).10 According to published studies, clinical inertia can affect Abstract