We’ve seen the statistics about the strides made in improving hemoglobin A 1c , blood pressure, and lipids in patients with diabetes in the past 10 years. Yet 33% to 49% of these individuals are still not at goal for glucose, blood pressure, or low-density lipoprotein cholesterol control—and a mere 14% are the targets for all 3 and are not smoking. We’re also well aware of the underlying obstacles, which include economic barriers, problems with access to care, knowledge deficits, and clinical inertia. The last obstacle cuts both ways—for the patient and the physician. Here’s an example of clinical inertia: the patient has been above goal for, say, glucose.
She never brings her self-monitoring blood glucose results to office visits. Her A1c values have been stagnant, hovering at 10.3% or higher. She says, “I’m going to get back on track. I don’t want to go on insulin, so can you give me…
