Type 2 Diabetes: After the Diagnosis, Resist Inertia

Meet your patient Mrs Davis. 48 y/o, T2DM, HTN, hyperlipidemia, obesity; takes metformin, BP meds, statin, baby aspirin.

First steps with new T2DM patient Mrs Davis: Counsel her on weight loss, send to CDE, refill Rx and testing supplies, remind her to bring glucometer/log book to next appointment, in 3 months.

Three-month T2DM follow-up: Mrs Davis has lost 4 lbs; BP is range; typical FPG 160-130; average blood sugar/30 days per meter is 189; she is encouraged to keep up the good work.

Six-month T2DM follow-up from initial visit: BP is increased (142/92 mmHg); she has regained weight she lost; A1c is 8.4; LDL is 132; she says she is really trying; she is counseled again on changing lifestyle habits to improve her health

Re-evaluating T2DM/comorbidity management. Over the course of 6 months, Mrs. Davis’ T2DM, HTN, LDL-C have gotten worse. How could the progressive decline have been prevented?

Clinical inertia in action: A1c. Blood sugar average at visit 1, 177; first follow-up, 30-day average SMBG was 189; repeat A1c at 6 months was 8.4 (up from 7.8). When should T2DM treatment have been intensified?

Clinical inertia in action: BP. Mrs Davis' blood pressure was initially within goal range; at 3 months was a top of the range, at 6 months, above goal. Optimally, when should HTN meds been adjusted?

Clinical inertia in action: LDL. LDL-C at presentation was 108, close to top of goal range; at 6 months it was 132. When should her statin have been increased?

Clinical inertia in action. Inertia is defined as "a tendency to remain unchanged." Medical management and lifestyle interventions should have been assessed/intensified at the initial or at least at 3-month follow-up.

Optimal T2DM management. What do guidelines recommend? Are treatment algorithms useful? Is home glucose monitoring data useful? If so, what aspects. Stay tuned for the next installment.