Impact of Therapeutic Inertia on Glycemic Control and Diabetes-Related Complications in Type 2 Diabetes: A 3-Year Retrospective Cohort Study.

Abstract

Background: Therapeutic inertia is a major barrier to optimal glycemic control in type 2 diabetes (T2DM), yet its impact in low-resource settings is not well-documented. This retrospective cohort study investigated the effect of therapeutic inertia on treatment outcomes in patients with T2DM receiving care at a tertiary hospital in southern Ethiopia.

Methods: A retrospective cohort study was conducted among 159 adult ambulatory T2DM patients between June 2020 and 2023. Data were collected from medical records. The primary outcome was poor treatment outcome, defined as fasting blood glucose > 130 mg/dL or development of a new diabetes-related complication. Exposure was defined as failure to intensify treatment within three months of uncontrolled glycemia. Cox proportional hazard models were used to assess the association between therapeutic inertia and poor treatment outcomes.

Results: The medical records of 159 T2DM patients were reviewed. Poor treatment outcomes were common in the therapeutic inertia group (68.6%). The therapeutic inertia exposure group was significantly associated with an increased risk of poor treatment outcomes, with an adjusted HR of 1.927 (95% CI: 1.201-3.092, p = 0.007). As a secondary analysis, factors such as physician qualification (p = 0.001), presence of comorbidities (p = 0.024), and the presence of neuropathy (p = 0.02) and nephropathy (p = 0.011) were significantly associated with therapeutic inertia.

Conclusion: Therapeutic inertia was significantly associated with worse treatment outcomes in this cohort. Healthcare systems should implement strategies to promote proactive diabetes management, while recognizing that therapeutic inertia is a complex issue influenced by patient, provider, and system factors. Future research should focus on identifying and overcoming the contextual barriers to timely treatment intensification.