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Therapeutic inertia in type 2 diabetes: prevalence, causes, consequences and methods to overcome inertia

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Khunti, Sachin, Khunti, Kamlesh, Seidu, Samuel·2019·Therapeutic Advances in Endocrinology and Metabolism
DOI 10.1177/2042018819844694PMC PMC6502982
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Abstract

Early glycaemic control leads to better outcomes, including a reduction in long-term macrovascular and microvascular complications. Despite good-quality evidence, glycaemic control has been shown to be inadequate globally. Therapeutic inertia has been shown present in all stages of treatment intensification, from the first oral antihyperglycaemic drug (OAD), all the way to the initiation of insulin. The causes and possible solutions to the problem of therapeutic inertia are complex but can be understood better when viewed from the perspective of the providers [healthcare professionals (HCPs)], patients and healthcare systems. In this review, we will discuss the possible aetiologies, consequences and solutions of therapeutic inertia, drawing upon evidence from published literature on the subject of type 2 diabetes.

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  • At the system level, healthcare issues, high costs, poor communication and coordination between departments, inadequate support technologies or insurance coverage, and regional differences of norms are important causes of therapeutic inertia.

    “At the system level, healthcare issues, high costs, poor communication and coordination between the departments, inadequate support technologies or insurance coverage, and regional differences of norms are some important causes of therapeutic inertia [13].”

    From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [13]

    The “Causes of therapeutic inertia > System level” section identifies healthcare-system issues, medication costs, differences between healthcare settings, and insurance coverage as barriers. It does not identify poor coordination between departments, inadequate support technologies, or regional differences in norms as causes. The copy provides no page numbers for these passages. (LLM, conf=0.86)

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  • At the provider level, lack of time, poor knowledge, varied or frequent guidelines, and fear of side effects such as hypoglycemia are major causes of therapeutic inertia.

    “At the provider’s level, lack of time, poor knowledge, varied or frequent guidelines, and fear of side effects such as hypoglycemia in diabetic patients are the major causes of therapeutic inertia.”

    From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [13]

  • Causes of therapeutic inertia are complex, multifactorial, and observed at three levels: provider, patient, and system barriers, which account for 50%, 30%, and 20% of therapeutic inertia causes, respectively.

    “Causes for therapeutic inertia are complex, multifactorial, and can be observed at three levels: the provider’s level, the patient’s level, and the system barriers level, which account for 50%, 30%, and 20% of therapeutic inertia causes, respectively [13].”

    From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [13]

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Research works printed but not linked: 39

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Authors
Khunti, S., Khunti, K., & Seidu, S.
Affiliations
  • Queen Mary University of London (GB)
  • University of Leicester (GB)
Corresponding author
Seidu, Samuel
ORCID
Venue
Therapeutic Advances in Endocrinology and Metabolism
Publisher
SAGE Publications
Published
2019-01
Volume
10
Pages
2042018819844694-2042018819844694
ISSN
  • 2042-0188 (ISSN-L)
  • 2042-0196
DOI
10.1177/2042018819844694
PMC
PMC6502982
OpenAlex
W2943649752
Cited by
182
References
13
Citations by year
2026: 19 · 2025: 19 · 2024: 24 · 2023: 29 · 2022: 31 · 2021: 40 · 2020: 19 · 2018: 1
FWCI
3.47
Type
journal article
Language
en
Open access
Licence
Locations
  • Therapeutic Advances in Endocrinology and Metabolism (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by-nc)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
  • Leicester Research Archive (University of Leicester) (submittedVersion, cc-by-nc)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
therapeutic inertia, type 2 diabetes, glycemic control, insulin initiation, treatment intensification, healthcare workers, patient factors, health care system, diabetes complications

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