Overcoming Therapeutic Inertia

Therapeutic Inertia in Managing Diabetes

Overcoming Therapeutic Inertia is a well-known problem in the management of diabetes. Treatment intensification may be delayed for a prolonged period due to several reasons.

Kamlesh Khunti, FMedSci, FRCGP, FRCP, MD, PhD, presented an overview of the scope and impact of therapeutic inertia as well as clinician barriers related to therapy intensification reported in the American Diabetes Association’s publication, Summary of the Proceedings of the American Diabetes Association Summit - Overcoming Therapeutic Inertia: Accelerating Diabetes Care For Life.²³

These barriers include the following:

• lack of time 
• lack of resources
• lack of training and education
• suboptimal patient medication-taking behavior
• perceptions about patients’ ability and willingness to follow treatment protocols
• hypoglycemia concerns and management of comorbidities

In this same publication, session participants were asked to share their ideas of the causes and impact of therapeutic inertia and to summarize that in one word. Words identified to describe the top contributors to therapeutic inertia were “time,” “cost,” “fear,” “apathy” and “overwhelmed.” Words identified to describe the solutions to address therapeutic inertia were “education” and “time.”

Results of a nationally representative, serial cross-sectional study of adults with diabetes were reported in JAMA in 2019’s “Evaluation of the Cascade of Diabetes Care in the United States, 2005-2016.”²⁴ The conclusion was that there was no significant improvement in diabetes care in the U.S. between 2005 and 2016.

Certainly, therapeutic inertia comes into play here. A Personal CGM program can address therapeutic inertia by identifying glycemic patterns and changing the treatment plan to address problem areas that are uncovered. Changing the treatment plan does not only entail making medication related interventions, but also, very importantly, includes an analysis of lifestyle factors and behavioral issues and a plan to overcome these obstacles.

A diabetes care and education specialist is a great person to have on your team to address these topics with people with diabetes, as they are skilled at coaching persons with diabetes in all aspects of self-management of their condition using an evidence-based framework, the ADCES7 Self-Care Behaviors^®.

The pharmacist is another important person to have on your team to provide their expertise related to medication management and medication related interventions, and for helping adjust medications based on results from personal CGM.