1. True clinical inertia exists only if:

1. recommendation exists;
2. provider knows the recommendation;
3. provider believes the recommendation applies to the patient;
4. provider has the necessary resources to apply the recommendation;

provider does not apply the recommendation for a particular patient, even though the conditions 1 to 4 are present.

b. Clinical inertia is defined as the failure to establish appropriate targets and escalate treatment to achieve treatment goals. It accounts for a significant proportion of failure to achieve targets in the management of diabetes.

c. Clinical inertia is a major cause of poor glycemic control. In India, it has been observed that insulin is not initiated in patients till their HbA1c reaches >9%. The lack of timely interventions is correlated with worsening glycemic control.

d. Interventions to overcome inertia: Education (CME); developing quality measures; effective use of information systems; personal feedback to HCPs; adherence to guidelines; adherence to medications; motivating and supporting patients on self-management.

e· T2DM is a progressive disease and is associated with several complications. Diabetes risk and progression are increased in the Indian population, especially in the younger age group.

f· Clinical inertia across treatment paradigm is common in practice, and there are several barriers to achieving tight glycemic control.

g· Different solutions are needed for different settings.

h· Urgent solutions are required for all patients, in view of increased prevalence of microvascular and macrovascular complications.