What Is Clinical Inertia and Does It Affect You?
Struggling with higher blood sugars? You may have also experienced clinical inertia and not even realized it.
Clinical inertia describes what happens if your medical provider does not advance your diabetes care, even though they recognize your blood sugars, blood pressure, or cholesterol are in unsafe ranges. It can also happen when your diabetes is being overtreated, and your medical team does not back off your diabetes care. Both of these most commonly happen when you’re needing changes to your diabetes medications.
What does clinical inertia look like?
Unfortunately, I’ve seen clinical inertia happen too often. A gentleman who is newly diagnosed and struggling with high blood sugars, despite lifestyle changes. A woman who called her provider multiple times to voice concerns about high blood sugars. An older gentleman with many health conditions taking a number of diabetes medications in an effort to get to an A1C too low for his age and health. None had changes made to their diabetes medications for several months, if at all.
This is not just a phenomenon I see, it’s been well documented in numerous studies, which show these delays can happen for years. In fact, the average delay in adding medication to a diabetes regimen is about 2-3 years. The delay for adding insulin about 7 years. Mind you, this all happens when you’re struggling with high blood sugars, putting you at risk for diabetes complications.
Why does clinical inertia happen?
It’s easy to look at clinical inertia as just a “problem” with your medical provider, but there’s a lot more to it than the blame game.
Reason #1: View of failure
Medication is too often viewed as a tool used if someone “failed” to manage diabetes with exercise and nutrition (which is not true - medications are a complementary tool to those pieces). Because of that, you and your provider may delay necessary medications — hoping that endless efforts at lifestyle changes will finally play out in the blood sugars.
Reason #2: Communication gaps
Communication errors are common, especially the more medical providers you see and the more hospitalizations you have. Responsibilities of helping you manage your diabetes shift between multiple people, making it challenging to understand who’s doing what, when.
Reason #3: Changing medications & technology
The speed at which diabetes medications and technologies have changed over the years is incredible! It’s hard enough for endocrinologists (diabetes doctors) to keep up, let alone a general medical provider who is responsible for managing many different medical conditions.
Add insurance barriers, cost, side effect fears, weight stigma, etc. into the mix and you end up with many layers to clinical inertia.
What can you do about clinical inertia?
There are two really important things you can do about clinical inertia.
Understand medication is okay
Start recognizing medications as an important and powerful tool for managing diabetes. Unfortunately, medications have become something of a shaming thing - where your doctor is seen as a “pill pusher” and you’re seen as a “failure” if you need them. That’s all wrong. We’re so fortunate that medical care has progressed tremendously in the past 100 years. The discovery of antibiotics, insulin, and even vaccines have been so impactful that your life span has nearly doubled in part due to these medications. Medications when used inappropriately, are dangerous. Medications when used well, are life-changing and lifesaving.
Be informed and ask questions to drive your healthcare. You and your medical provider want the same thing - for you to have a long, productive, healthy life. Asking questions does not mean you’re “questioning” your provider, rather, it’s a way to get on the same page with them. It’s hard to make decisions about your care and be invested when you don’t understand what’s happening, or what should happen. Do your research, be proactive and ask your questions, express concern if you feel confused or overwhelmed, and ask for referrals to endocrinologists and for diabetes self-management training. You’ve got this!
Do you live with any sleep disorders (eg. insomnia, sleep apnea, RLS) in addition to your diabetes?