Diabetes and Vascular Research Centre, University of Exeter Medical School, Barrack Road, Exeter EX25AX, UK.
Sant Marti de Provençals Primary Health Care Centre, Institut Català de la Salut, Generalitat de Catalunya, C/ Fluvià 211, 08020 Barcelona, Spain.
Diabetes Res Clin Pract. 2014 Sep;105(3):302-12. doi: 10.1016/j.diabres.2014.05.005. Epub 2014 May 27.
Clinical inertia, the tendency to maintain current treatment strategies despite results demanding escalation, is thought to substantially contribute to the disconnect between clinical aspirations for patients with diabetes and targets achieved. We wished to explore potential causes of clinical inertia among physicians and people with diabetes.
A 20-min online survey of 652 adults with diabetes and 337 treating physicians in six countries explored opinions relating to clinical inertia from both perspectives, in order to correlate perceptions and expectations relating to diagnosis, treatment, diabetes complications and therapeutic escalation.
Physicians had low expectations for their patients, despite the belief that the importance of good glycaemic control through lifestyle and pharmacological interventions had been adequately conveyed. Conversely, people with diabetes had, at best, a rudimentary understanding of the risks of complications and the importance of good control; indeed, only a small proportion believed lifestyle changes were important and the majority did not intend to comply.
The principal findings of this survey suggest that impairments in communication are at the heart of clinical inertia. This manuscript lays out four key principles that we believe are achievable in all environments and can improve the lives of people with diabetes.
临床惰性是指尽管结果需要升级，但仍倾向于维持当前治疗策略的趋势，据认为这在很大程度上导致了糖尿病患者的临床期望与目标之间存在脱节。我们希望探讨医生和糖尿病患者中临床惰性的潜在原因。
在六个国家，对 652 名成年糖尿病患者和 337 名治疗医生进行了 20 分钟的在线调查，从两个角度探讨了与临床惰性相关的意见，以便将与诊断、治疗、糖尿病并发症和治疗升级相关的看法和期望进行关联。
尽管医生认为通过生活方式和药物干预来控制良好的血糖水平非常重要，但他们对患者的期望较低。相反，糖尿病患者对并发症的风险和良好控制的重要性只有最基本的了解；事实上，只有一小部分人认为生活方式的改变很重要，而大多数人并不打算遵守。
这项调查的主要发现表明，沟通障碍是临床惰性的核心。本文提出了四项我们认为在所有环境中都可以实现的关键原则，可以改善糖尿病患者的生活。
