Association between therapeutic inertia and future hypoglycemia among patients with type 2 diabetes

Abstract

Introduction

Therapeutic inertia (TI), the failure to adjust therapy when HbA1c remains above- target, is a barrier to optimal glycemic control in type 2 diabetes (T2D). This study examined the association between TI and subsequent-year hypoglycemia visit, and whether continuous glucose monitoring (CGM) modifies this relationship.

Methods

We analyzed electronic health records (2017–2023) from two Midwest US healthcare systems, including adults with T2D, at least one above-target HbA1c (>7% for ages 18–64; >8% for ages ≥65), and glucose-lowering prescriptions. TI was calculated annually as the percentage of above-target HbA1c results without prescription changes within 30 days. We fitted logistic regression models to examine whether high TI (>50%) was associated with subsequent-year hypoglycemia visits. An interaction term tested whether this association differed between those who used vs. did not use CGM.

Results

Among 65,983 participants (mean age 56, 51% male, 75% White), mean HbA1c at last follow-up was 8.1% (ages 18–64) and 8.0% (ages ≥ 65). High TI was associated with 74% increased odds of hypoglycemia visit (OR = 1.74; 95% CI: 1.61–1.88; p < 0.001). Insulin users had threefold higher odds (OR = 2.95; p < 0.001). Medicare beneficiaries had 47% higher odds than Medicaid beneficiaries. Adults aged 18–44 years had more hypoglycemia visits compared to other age groups. Low CGM use (7%) limited the interpretation of interaction effects (95% CI: 0.47–1.1, p = 0.12).

Conclusions

In this cohort, high TI predicted hypoglycemia-visit. Further research is needed to understand TI drivers and how to balance improving glycemic control without increasing the risk of hypoglycemia.