Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review.

This review seeks to establish, through the recent available literature, the prevalence of therapeutic intensification delay and its sequences in poorly controlled Type 2 Diabetes Mellitus (T2DM) patients. The strategy identified studies exploring the clinical inertia and its associated factors in the treatment of patients with T2DM. A total of 25 studies meeting the pre-established quality criteria were included in this review. These studies were conducted between 2004 and 2021 and represented 575,067 patients diagnosed with T2DM. Trusted electronic bibliographic databases, including Medline, Embase, and the Cochrane Central Register of Controlled Trials, were used to collect studies by utilizing a comprehensive set of search terms to identify Medical Subject Headings (MeSH) terms. Most o the studies included in this review showed clinical inertia rates over 50% of T2DM patients. In the USA, clinical inertia ranged from 35.4% to 85.8%. In the UK, clinical inertia ranged from 22.1% to 69.1%. In Spain, clinical inertia ranged from 18.1% to 60%. In Canada, Brazil, and Thailand, clinical inertia was reported as 65.8%, 68%, and 68.4%, respectively. The highest clinical inertia was reported in the USA (85.8%). A significant number of patients with T2DM suffered from poor glycemic control for quite a long time before treatment intensification with oral antidiabetic drugs (OADs) or insulin. Barriers to treatment intensification exist at the provider, patient, and system levels. There are deficiencies pointed out by this review at specialized centers in terms of clinical inertia in the management of T2DM including in developed countries. This review shows that the earlier intensification in the T2DM treatment is appropriate to address issues around therapeutic inertia.

Physicians' Practice of the Non-Cosmetic Uses of Botulinum Toxin: A Cross-Sectional Study in Saudi Arabia.

Background Although botulinum toxin (BTX) has mainly been used cosmetically and therapeutically, its field of application is expanding. So far, BTX has shown promising outcomes in the management of a wide variety of medical conditions that are difficult to treat. Objectives We assessed physicians' knowledge and experience regarding the non-cosmetic use of BTX in different clinical settings. Methods This is a cross-sectional survey that was conducted in Riyadh, Saudi Arabia, and included physicians from different specialties, with different levels of training, and from different working hospitals. Data were collected by using a self-administered survey to assess physicians' knowledge, experience, current practice, and specific training in relation to Botox administration for non-cosmetic use. Results Most participants were residents (76.19%) and specialized in internal medicine (27.62%). The majority worked in governmental hospitals (76.19%). About 73% of our sample were aware of the non-cosmetic indications of BTX, but only 44% and 55% were aware of its contraindications and adverse effects, respectively. Less than one-third (31%) of respondents administered BTX injections in their clinical practice, and about 66% of respondents had two to five years of experience giving BTX injections. The most commonly treated conditions were spastic disorders, dystonia, and then migraine. Only 4.7% and 3.6% used validated scales or instruments for planning treatment with BTX, respectively, while about 36% opted for clinical evaluation only. More experience and training in giving BTX injections significantly predicted increased awareness of adverse effects and contraindications of non-cosmetic uses.  Conclusions The majority of specialty groups in our sample were aware of the non-cosmetic applications of botulinum toxin but did not use them to the same extent in their practice. Additionally, only a minority wished for further education on injection practices. The finding of insufficient knowledge about contraindications and the adverse effects of injections in a large number of participants, however, highlights the need for increased education, especially given the wide range of non-cosmetic applications and benefits that BTX can have for a variety of diseases.