Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital APHP and EA 3412, CRNH-IdF, Paris 13 University, 93017 Bobigny, France.
Lilly Diabetes, Eli Lilly & Company, 92521 Neuilly-sur-Seine, France.
Diabetes Metab. 2017 Dec;43(6):501-511. doi: 10.1016/j.diabet.2017.06.003. Epub 2017 Jul 25.
Many people with type 2 diabetes mellitus (T2DM) fail to achieve glycaemic control promptly after diagnosis and do not receive timely treatment intensification. This may be in part due to 'clinical inertia', defined as the failure of healthcare providers to initiate or intensify therapy when indicated. Physician-, patient- and healthcare-system-related factors all contribute to clinical inertia. However, decisions that appear to be clinical inertia may, in fact, be only 'apparent' clinical inertia and may reflect good clinical practice on behalf of the physician for a specific patient. Delay in treatment intensification can happen at all stages of treatment for people with T2DM, including prescription of lifestyle changes after diagnosis, introduction of pharmacological therapy, use of combination therapy where needed and initiation of insulin. Clinical inertia may contribute to people with T2DM living with suboptimal glycaemic control for many years, with dramatic consequences for the patient in terms of quality of life, morbidity and mortality, and for public health because of the huge costs associated with uncontrolled T2DM. Because multiple factors can lead to clinical inertia, potential solutions most likely require a combination of approaches involving fundamental changes in medical care. These could include the adoption of a person-centred model of care to account for the complex considerations influencing treatment decisions by patients and physicians. Better patient education about the progressive nature of T2DM and the risks inherent in long-term poor glycaemic control may also reinforce the need for regular treatment reviews, with intensification when required.
许多 2 型糖尿病（T2DM）患者在诊断后未能迅速控制血糖，也未及时接受治疗强化。这可能部分归因于“临床惰性”，即医疗保健提供者未能在需要时启动或强化治疗。医生、患者和医疗系统相关因素都促成了临床惰性。然而，看似临床惰性的决策实际上可能只是“表面”的临床惰性，可能反映了医生针对特定患者的良好临床实践。T2DM 患者的治疗强化延迟可能发生在治疗的各个阶段，包括诊断后生活方式改变的处方、药物治疗的引入、需要时联合治疗的使用以及胰岛素的起始。临床惰性可能导致 T2DM 患者多年来血糖控制不理想，对患者的生活质量、发病率和死亡率产生巨大影响，对公共卫生也造成巨大的费用负担，因为未控制的 T2DM 相关成本巨大。由于多种因素可能导致临床惰性，潜在的解决方案可能需要结合多种方法，包括对医疗保健进行根本性改变。这些方法可能包括采用以患者为中心的护理模式，以考虑影响患者和医生治疗决策的复杂因素。更好地教育患者了解 T2DM 的渐进性和长期血糖控制不佳的固有风险，也可能强化定期治疗评估的必要性，在需要时进行强化。
