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In reply

Finucane asks whether the failure of primary care providers to intensify therapy for patients with diabetes who have high glucose levels—"clinical inertia"—might reflect the view that tight glycemic control has not yet been proven to benefit patients with type 2 diabetes mellitus. Moreover, providers rarely questioned the hemoglobin A_1c goal of lower than 7.0% during performance feedback sessions, and intensification at all levels of glucose improved with the Improving Primary Care of African Americans With Diabetes (IPCAAD) intervention.¹

More broadly, we are concerned about "RCTomyopia" (belief that clinical action can be justified only by randomized, controlled trials) and "evidence-based paralysis" (unwillingness to take action without incontrovertible proof from controlled trials). We believe that responsible physicians and patients should make decisions based on the best available evidence—including cell and animal studies, observational studies, and controlled trials, if available—and that the strengths and weaknesses of the findings with each approach . . . [Full Text of this Article]

AUTHOR INFORMATION
David C. Ziemer, MD; Lawrence S. Phillips, MD

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An Intervention to Overcome Clinical Inertia and Improve Diabetes Mellitus Control in a Primary Care Setting: Improving Primary Care of African Americans With Diabetes (IPCAAD) 8
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