Medical Affairs, Novo Nordisk Canada, Inc, Mississauga, Ontario, Canada.
Real World Solutions, IQVIA, Mississauga, Ontario, Canada.
Can J Diabetes. 2021 Apr;45(3):273-281.e13. doi: 10.1016/j.jcjd.2020.08.109. Epub 2020 Sep 7.
The objectives of this review were to: 1) examine recent strategies and component interventions used to overcome therapeutic inertia in type 2 diabetes mellitus (T2DM), 2) map strategies to the causes of therapeutic inertia they target and 3) identify causes of therapeutic inertia in T2DM that have not been targeted by recent strategies. A systematic search of the literature published from January 2014 to December 2019 was conducted to identify strategies targeting therapeutic inertia in T2DM, and key strategy characteristics were extracted and summarized. The search identified 46 articles, employing a total of 50 strategies aimed at overcoming therapeutic inertia. Strategies were composed of an average of 3.3 interventions (range, 1 to 10) aimed at an average of 3.6 causes (range, 1 to 9); most (78%) included a type of educational strategy. Most strategies targeted causes of inertia at the patient (38%) or health-care professional (26%) levels only and 8% targeted health-care-system-level causes, whereas 28% targeted causes at multiple levels. No strategies focused on patients' attitudes toward disease or lack of trust in health-care professionals; none addressed health-care professionals' concerns over costs or lack of information on side effects/fear of causing harm, or the lack of a health-care-system-level disease registry. Strategies to overcome therapeutic inertia in T2DM commonly employed multiple interventions, but novel strategies with interventions that simultaneously target multiple levels warrant further study. Although educational interventions are commonly used to address therapeutic inertia, future strategies may benefit from addressing a wider range of determinants of behaviour change to overcome therapeutic inertia.
1）研究克服 2 型糖尿病治疗惰性的最新策略和组成干预措施；2）将策略与针对的治疗惰性原因相对应；3）确定尚未被最新策略针对的 2 型糖尿病治疗惰性原因。从 2014 年 1 月至 2019 年 12 月，我们系统性地检索了文献，以确定针对 2 型糖尿病治疗惰性的策略，并提取和总结了关键策略特征。该检索共识别出 46 篇文章，共采用了 50 种旨在克服治疗惰性的策略。这些策略由平均 3.3 种干预措施（范围为 1 至 10）组成，旨在针对平均 3.6 种原因（范围为 1 至 9）；其中大多数（78%）包括一种教育策略。大多数策略仅针对患者（38%）或医疗保健专业人员（26%）层面的惰性原因，8%针对医疗保健系统层面的原因，而 28%针对多个层面的原因。没有策略针对患者对疾病的态度或对医疗保健专业人员的信任缺失；没有任何策略解决医疗保健专业人员对成本的担忧或对副作用/害怕造成伤害的信息缺乏，或缺乏医疗保健系统层面的疾病登记。克服 2 型糖尿病治疗惰性的策略通常采用多种干预措施，但具有同时针对多个层面干预措施的新策略值得进一步研究。尽管教育干预措施常用于解决治疗惰性问题，但未来的策略可能受益于解决更广泛的行为改变决定因素，以克服治疗惰性。
