A Retrospective Analysis of Therapeutic Inertia in Type 2 Diabetes Management Across a Diverse Population of Health Care Organizations in the USA

Cori R Rattelman, Elizabeth L Ciemins, Nikita Stempniewicz, Michelle Mocarski, Rahul Ganguly, John K Cuddeback
2021 Diabetes Therapy  
If their target glycated hemoglobin (HbA1c) is not achieved after 3 months, timely treatment intensification is recommended in people with type 2 diabetes to maintain glycemic control and minimize vascular complications. We retrospectively investigated potential therapeutic inertia in the management of type 2 diabetes in multiple health care organizations across the USA. Electronic health records were analyzed from 22 American Medical Group Association (AMGA) health care organizations. Bolus
more » ... ulin-naïve patients with type 2 diabetes and HbA1c ≥ 8.0% (≥ 64 mmol/mol) at baseline were followed for 24 months to identify the frequency and average duration of therapeutic inertia (no new class of glucose-lowering medication prescribed, or not achieving their target HbA1c [< 8.0%; < 64 mmol/mol]). The study cohort comprised almost 28,000 patients. Therapeutic inertia was observed in ≈ 50% of patients after 6 months, and in > 10% after 24 months. Less therapeutic inertia was observed in patients receiving one or no oral antidiabetic drugs (OADs) (36% or 28%, respectively, at 6 months), while more inertia was seen following multiple OADs or basal insulin (54% of those on baseline basal insulin at 6 months). Although an observable action was recorded for 90% of patients, many (44%) had still not achieved their target HbA1c after 24 months. The results corroborate the presence of therapeutic inertia in people with type 2 diabetes, suggesting that treatment intensification guidelines are not being followed. Extensive variability in the presence of therapeutic inertia was observed both across and within organizations; investigating this further and sharing best practices across providers might help improve the quality of patient care at organizational and national levels.
doi:10.1007/s13300-020-00993-w pmid:33460018 pmcid:PMC7846632 fatcat:xje4dky5drgltpermqdsg3bubm