Metabolic Institute of America, Tarzana, CA 91356, USA.
J Clin Hypertens (Greenwich). 2011 Aug;13(8):613-20. doi: 10.1111/j.1751-7176.2011.00490.x. Epub 2011 Jul 14.
Type 2 diabetes mellitus (T2DM) is characterized by progressively worsening hyperglycemia that leads to microvascular and macrovascular complications. Optimal management of T2DM aims to simultaneously control hyperglycemia, hypertension, and dyslipidemia to reduce the overall risk. However, a large proportion of patients in clinical practice do not reach treatment targets. Some of the obstacles to achieving treatment targets include high medication costs, costs associated with health insurance, poor patient adherence to medication, patient fear of potential adverse effects, improper patient education, and failure by health care providers to appropriately initiate or intensify therapy (clinical inertia). Possible causes of clinical inertia include the influence exerted on physicians by reluctant patients and the influence of media-driven attention and the negative spin of clinical trial results on physicians' prescribing behavior and on patients' attitudes towards treatment. This negative publicity can be disproportionate to the overall body of scientific evidence and may, therefore, prove to be unfounded in the long-term. There is clear evidence of the benefits of the effective management of T2DM to achieve goals. Overcoming the obstacles to achieving treatment targets may include use of strategies such as early intensive treatment and combination therapy with drugs with complementary mechanisms of action.
2 型糖尿病（T2DM）的特征是血糖逐渐恶化，导致微血管和大血管并发症。T2DM 的最佳治疗方案旨在同时控制高血糖、高血压和血脂异常，以降低整体风险。然而，在临床实践中，很大一部分患者未达到治疗目标。未能达到治疗目标的部分障碍包括药物费用高、医疗保险相关费用、患者对药物的依从性差、患者对潜在不良反应的恐惧、患者教育不当以及医疗保健提供者未能适当启动或强化治疗（临床惰性）。临床惰性的可能原因包括不情愿的患者对医生的影响，以及媒体驱动的关注和临床试验结果的负面效应对医生的处方行为和患者对治疗的态度的影响。这种负面宣传可能与整体科学证据不成比例，因此从长期来看可能是没有根据的。有效管理 T2DM 以实现目标的益处有明确的证据。克服实现治疗目标的障碍可能包括采用早期强化治疗和具有互补作用机制的药物联合治疗等策略。
