A Multicenter Italian Survey on Diabetes Care Units Reveals a Somewhat Slow Attitude in Treatment Guideline Implementation: Are We Dealing With Therapeutic Inertia?
Strategies and goals of diabetes mellitus treatment have changed fast since 2005.
Randomized clinical trials including the Diabetes Control and Complications
Trial-Epidemiology of Diabetes Interventions and Complications
United Kingdom Prospective Diabetes Study and STENO 23 consistently reported
a better prognosis in patients starting intensive treatment regimens early
after diagnosis compared to those achieving acceptable HbA1c levels later on.
Such findings were supported by basic science, suggesting irreversible beta-cell damages
as a consequence of oxidative stress due to prolonged exposure to high glucose concentrations.
A strong clinical message was then sent out to pursue optimal metabolic
management ever since the onset of the disease.
In spite of this, attaining and maintaining an adequate metabolic control are still a challenge.
In fact, a recent report on diabetes care quality indicators in Italy showed that over 50%
people with T2DM fail to meet expected metabolic targets, and
approximately 30% of newly diagnosed patients have a HbA1c >8.0% (>64 mol/mol).
Among the many factors suggested to explain failure to achieve recommended goals, clinical inertia is
increasingly recognized as the leading one. Patients on metformin or sulfonylurea monotherapy starting treatment intensification only after overcoming.
HbA1c levels are expected to take 2 to 3 years to get good metabolic control.
On the other hand, opinions concerning the most appropriate therapeutic algorithm
to be adopted in these cases are controversial.
Diabetes Res Open J. 2016; 2(2): 33-44. doi: 10.17140/DROJ-2-127