Paradigms in Insulin Use for Type 2 Diabetes - Episode 3

Clinical Inertia in Treatment of Type 2 Diabetes

Jennifer Brigitte Green, MD, discusses the reasoning behind clinical inertia in treating patients with type 2 diabetes and comments on achieving and maintaining glycemic control over an extended period.

Jennifer Brigitte Green, MD: There is quite a lot of clinical inertia in the management of type 2 diabetes, and I think that there are many reasons for that, and it’s an issue on the part of both the diabetes care provider and the person affected by type 2 diabetes. There tends to be always a desire to make additional lifestyle changes in order to improve glycemic control. That is not to say that lifestyle modification is not important in the management of type 2 diabetes, it’s really the foundation of care, but often lifestyle modification will not be adequate to manage type 2 diabetes. Thus, we do need to make sure that we move past what is kind of a natural desire on the part of everyone to minimize the number of medications that are taken and to rely on lifestyle changes to achieve glycemic goals. It just, unfortunately, doesn’t happen as often as we would like to see it. Now, the other thing that I think is often forgotten or not understood about type 2 diabetes is that the traditional stepped approach to glycemic management, the one that we’ve implemented really for decades in the management of type 2 diabetes, unfortunately, doesn’t seem to be very effective in either achieving or maintaining good glycemic control over time.

There are many studies of early type 2 diabetes management that have been published that have shown that combination therapy implemented right from the start of a diagnosis of type 2 diabetes is a much more effective approach, again, in achieving glycemic goals and maintaining good glycemic control for extended periods. Then, there is the approach where traditionally you start someone on a given medication, they essentially fail because they have inadequate glycemic control at some point on that medicine. And then at that point, perhaps a fairly long time after it’s clear that they failed that regimen, another medication is added. I think if we perhaps shift our thinking to the use of combinations of medicines that work in complementary physiologic ways very early in the lifetime of someone with type 2 diabetes, we may be able to change that trajectory, and inertia may become less of a problem.

Transcript Edited for Clarity