Although type 2 diabetes mellitus (T2DM) cannot be completely cured, however, there is a consensus that timely community management of T2DM patients following guidelines can lead to good glycemic control. However, blood glucose of the patients is chronically suboptimal due to T2DM-related clinical inertia. It is crucial for improving the effectiveness of diabetes control to determine the current status and influencing factors of clinical inertia in T2DM patients in community, but there is limited literature on this topic.

To investigate current status and influencing factors of clinical inertia during health management in T2DM patients in community.

From January to December 2020, T2DM patients receiving health management services from the national basic public health services in Qingjiangpu and Huaian Districts, Huaian City, Jiangsu Province, were recruited using cluster random sampling method to perform face-to-face questionnaire survey, physical examination, and laboratory tests. Clinical inertia was defined as the absence of intensification in antidiabetic treatment for patients with inadequate HbA_1c control (HbA_1c≥7.0%) in the past three months. Stepwise multiple Logistic regression analysis was performed to identify influencing factors of the detection of clinical inertia in T2DM patients in community.

A total of 3 346 T2DM patients with inadequate glycemic control (HbA_1c≥7.0%) were included in the study, with the overall detection rate of clinical inertia in T2DM patients of 93.96% (3 144/3 346), 94.84% (1 139/1 201) in men and 93.47% (2 005/2 145) in women, respectively. There were significant differences in the detection rate of clinical inertia among T2DM patients with different levels of dietary control, physical activity, blood glucose monitoring periods, diabetic complications, dyslipidemia (history), and history of coronary heart disease, stroke, and cancer. Stepwise multiple Logistic regression analysis showed that dietary control〔OR (95%CI) =0.585 (0.382, 0.894) 〕, glucose monitoring period≤1 week〔OR (95%CI) =0.470 (0.344, 0.644) 〕, presence of diabetic complications〔OR (95%CI) =0.606 (0.423, 0.868) 〕, dyslipidemia (history) 〔OR (95%CI) =0.725 (0.532, 0.988) 〕, history of coronary artery disease〔OR (95%CI) =0.659 (0.458, 0.949) 〕, and stroke〔OR (95%CI) =0.699 (0.511, 0.955) 〕were associated with a lower prevalence of clinical inertia in T2DM patients (P<0.05) .

There is a serious problem of clinical inertia in T2DM patients undergoing health management in community, the prevalence of clinical inertia is closely related to patients' dietary control, glucose monitoring period, presence of diabetic complications, and comorbid diseases (history) .

虽然2型糖尿病（T2DM）不能被彻底治愈，但遵循指南对T2DM患者进行及时的社区管理可以使其血糖得到良好控制，这已成为共识。然而由于T2DM相关临床惰性的影响，患者血糖长期处于不达标状态。了解社区T2DM患者临床惰性的现状及影响因素对提高糖尿病控制效果具有重要意义，但目前相关研究较少。

调查社区T2DM患者接受健康管理过程中临床惰性的现状，并分析其影响因素。

2020年1—12月，采用整群随机抽样法，选取江苏省淮安市清江浦区和淮安区参与国家基本公共卫生服务项目的社区T2DM患者为研究对象，对其进行"面对面"的问卷调查、体格检查及实验室检查。将糖化血红蛋白（HbA_1c）控制未达标（HbA_1c≥7.0%）的T2DM患者过去3个月未升级治疗定义为存在临床惰性。采用多因素逐步Logistic回归分析社区T2DM患者临床惰性检出情况的影响因素。

共纳入3 346名HbA_1c未达标的社区T2DM患者，社区T2DM患者临床惰性总体检出率为93.96%（3 144/3 346），其中男性检出率为94.84%（1 139/1 201），女性检出率为93.47%（2 005/2 145）。不同饮食控制情况、体育锻炼情况、血糖监测周期、糖尿病并发症发生情况，以及血脂异常（史）、冠心病史、脑卒中史、肿瘤病史情况的社区T2DM患者临床惰性检出率比较，差异有统计学意义（P<0.05）。多因素逐步Logistic回归分析结果显示，控制饮食〔OR（95%CI）=0.585（0.382，0.894）〕、血糖监测周期≤1周〔OR（95%CI）=0.470（0.344，0.644）〕、有糖尿病并发症〔OR（95%CI）=0.606（0.423，0.868）〕、有血脂异常（史）〔OR（95%CI）=0.725（0.532，0.988）〕、有冠心病史〔OR（95%CI）=0.659（0.458，0.949）〕及脑卒中史〔OR（95%CI）=0.699（0.511，0.955）〕的社区T2DM患者出现临床惰性的可能性更小（P<0.05）。

社区T2DM患者接受健康管理过程中存在严重的临床惰性问题，临床惰性的出现情况与其饮食控制情况、血糖监测周期、糖尿病并发症发生情况及合并疾病（史）情况有关联。