Does Clinical Inertia Vary by Personalized A1C Goal? A Study of Predictors and Prevalence of Clinical Inertia In A U.S. Managed-Care Setting
Abstract
Objective Clinical inertia is defined as failure to initiate or intensify therapy despite an inadequate treatment response. We assessed the prevalence and identified the predictors of clinical inertia among patients with type 2 diabetes (T2DM) based on personalized goals. Methods Three hemoglobin A1c (A1C) targets (American Diabetes Association A1C Results Irrespective of A1C target, the majority of patients with T2DM (70.4 to 72.8%) experienced clinical inertia in the 6 months following the index event, with 5.3 to 6.2% of patients intensifying treatment with insulin. Patients with a lower likelihood of intensification were older, used >1 oral antidiabetes drug during the baseline period, and had an above-target A1C more recently. Treatment intensification was associated with patients who had point-of-service insurance, mental illness, an endocrinologist visit in the baseline period, or higher index A1C. Conclusion The prevalence of clinical inertia among patients with T2DM in a U.S. managed-care setting is high and has increased over more recent years. Factors predicting increased risk of clinical inertia may help identify "at-risk" populations and assist in developing strategies to improve their management.
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Higher Charlson Comorbidity Index score, Point-of-Service insurance, high index HbA1c, baseline endocrinologist visit, and use of comedications were associated with a reduced likelihood of clinical inertia.
“In contrast, a higher Charlson Comorbidity Index (CCI) score, Point-of-Service (POS) insurance, a high index HbA1c, a baseline endocrinologist visit, and the use of comedications were associated with a reduced likelihood of clinical inertia [34].”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [34]
A higher Charlson Comorbidity Index score predicts the likelihood of treatment intensification or reduced clinical inertia.
“However, they reported that a higher CCI score, POS insurance, high index HbA1c, baseline endocrinologist visit, and use of comedications predict the likelihood of treatment intensification or reduced clinical inertia.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [34]
POS insurance predicts the likelihood of treatment intensification or reduced clinical inertia.
“However, they reported that a higher CCI score, POS insurance, high index HbA1c, baseline endocrinologist visit, and use of comedications predict the likelihood of treatment intensification or reduced clinical inertia.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [34]
A baseline endocrinologist visit predicts the likelihood of treatment intensification or reduced clinical inertia.
“However, they reported that a higher CCI score, POS insurance, high index HbA1c, baseline endocrinologist visit, and use of comedications predict the likelihood of treatment intensification or reduced clinical inertia.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [34]
High index HbA1c predicts the likelihood of treatment intensification or reduced clinical inertia.
“However, they reported that a higher CCI score, POS insurance, high index HbA1c, baseline endocrinologist visit, and use of comedications predict the likelihood of treatment intensification or reduced clinical inertia.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [34]
Above-target HbA1c predicts a lower likelihood of treatment intensification in type 2 diabetes mellitus.
“Lin et al. [34] reported that old age, use of more than one OAD, use of CCBs, and above-target HbA1c predict a lower likelihood of intensification.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [34]
Use of calcium channel blockers predicts a lower likelihood of treatment intensification in type 2 diabetes mellitus.
“Lin et al. [34] reported that old age, use of more than one OAD, use of CCBs, and above-target HbA1c predict a lower likelihood of intensification.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [34]
Use of more than one oral antidiabetic drug predicts a lower likelihood of treatment intensification in type 2 diabetes mellitus.
“Lin et al. [34] reported that old age, use of more than one OAD, use of CCBs, and above-target HbA1c predict a lower likelihood of intensification.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [34]
Old age predicts a lower likelihood of treatment intensification in type 2 diabetes mellitus.
“Lin et al. [34] reported that old age, use of more than one OAD, use of CCBs, and above-target HbA1c predict a lower likelihood of intensification.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [34]
Use of comedications predicts the likelihood of treatment intensification or reduced clinical inertia.
“However, they reported that a higher CCI score, POS insurance, high index HbA1c, baseline endocrinologist visit, and use of comedications predict the likelihood of treatment intensification or reduced clinical inertia.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [34]
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- Authors
- Lin, J., Zhou, S., Wei, W., Pan, C., Lingohr-Smith, M., & Levin, P.
- Affiliations
- Sanofi (United States) (US)
- Model Clinical Research (US)
- Corresponding author
- Lin, Jay
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2016-02
- Volume
- 22
- Issue
- 2
- Pages
- 151-161
- ISSN
- 1530-891X (ISSN-L)
- OpenAlex
- W1752565673
- Cited by
- 52
- References
- 33
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2023: 6 · 2022: 1 · 2021: 2 · 2020: 6 · 2019: 5 · 2018: 9 · 2017: 10 · 2016: 5 · 2015: 1
- FWCI
- 7.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine Practice (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sanofi
- Novo Nordisk
- 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
- clinical inertia, type 2 diabetes, glycemic control, treatment intensification, insulin initiation, managed care, mental illness
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Attitude of Health Personnel, Clinical Competence, Diabetes Mellitus, Type 2, Female, Goals, Glycated Hemoglobin, Humans, Male, Managed Care Programs, Middle Aged, Retrospective Studies, United States, Prevalence, Young Adult, Precision Medicine, Physicians, Primary Care, Time-to-Treatment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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