Western Washington Medical Group, Diabetes and Nutrition Education, Bothell, WA, USA.
Virginia Mason Medical Center, Lynnwood, WA, USA.
Adv Ther. 2018 Nov;35(11):1735-1745. doi: 10.1007/s12325-018-0819-5. Epub 2018 Oct 29.
The current epidemic of type 2 diabetes (T2D) represents a significant global and national health concern. Globally, the prevalence of diabetes has doubled between 1980 and 2014. In 2014 the World Health Organization estimated that there were 422 million adults living with diabetes worldwide. In the USA, the number of people diagnosed with T2D is estimated to increase to over 70 million by 2050, putting an immense strain on the US healthcare system. Achieving glycemic control is widely acknowledged as the key goal of treatment in T2D and is critical for reducing the onset and progression of diabetes-related complications such as cardiovascular diseases, neuropathies, retinopathies, and nephropathies. Despite the increase in the availability of antihyperglycemic medications and evidence-based treatment guidelines, the proportion of people with T2D who fail to achieve glycemic goals continues to rise. One major contributor is a delay in treatment intensification despite suboptimal glycemic control, referred to as clinical or therapeutic inertia. Clinical inertia prolongs the duration of patients' hyperglycemia which subsequently puts them at increased risk of diabetes-associated complications and reduced life expectancy. Clinical inertia results from a complex interaction between patient, healthcare providers, and healthcare system barriers that need to be addressed together, rather than as separate entities. In this article we provide an overview of clinical inertia in the clinical management of T2D and provide suggestions for overcoming aspects that may have a negative impact on patient care.Funding: Sanofi US, Inc.
目前,2 型糖尿病(T2D)的流行是一个重大的全球性和国家性健康问题。在全球范围内,糖尿病的患病率在 1980 年至 2014 年间翻了一番。2014 年,世界卫生组织估计全球有 4.22 亿成年人患有糖尿病。在美国,预计到 2050 年,被诊断患有 T2D 的人数将增加到 7000 多万,这给美国的医疗保健系统带来了巨大的压力。实现血糖控制被广泛认为是 T2D 治疗的关键目标,对于减少糖尿病相关并发症(如心血管疾病、神经病变、视网膜病变和肾病)的发生和进展至关重要。尽管有更多的抗高血糖药物和循证治疗指南可供使用,但未能达到血糖目标的 T2D 患者比例仍在上升。一个主要原因是尽管血糖控制不理想,但治疗强化的延迟,这被称为临床或治疗惰性。临床惰性延长了患者高血糖的持续时间,使他们面临更高的糖尿病相关并发症风险和预期寿命缩短的风险。临床惰性是由患者、医疗保健提供者和医疗保健系统障碍之间复杂的相互作用造成的,需要共同解决,而不是作为独立的实体。在本文中,我们概述了 T2D 临床管理中的临床惰性,并提出了克服可能对患者护理产生负面影响的方面的建议。资助:赛诺菲美国公司。
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