Addressing Therapeutic Inertia in 2020 and Beyond: A 3-Year Initiative of the American Diabetes Association

Abstract

Research has shown that getting to glycemic targets early on leads to better outcomes in people with type 2 diabetes; yet, there has been no improvement in the attainment of A1C targets in the past decade. One reason is therapeutic inertia: the lack of timely adjustment to the treatment regimen when a person's therapeutic targets are not met. This article describes the scope and priorities of the American Diabetes Association's 3-year Overcoming Therapeutic Inertia Initiative. Its planned activities include publishing a systematic review and meta-analysis of approaches to reducing therapeutic inertia, developing a registry of effective strategies, launching clinician awareness and education campaigns, leveraging electronic health record and clinical decision-support tools, influencing payer policies, and potentially executing pragmatic research to test promising interventions.

FIGURE 1

Type 2 diabetes trends in the United States, 2006–2013. Advances in health technologies, drug therapies, and public policy have not translated to improvements in diabetes care quality. ACO, accountable care organization; DPP-4i, dipeptidyl peptidase 4 inhibitor; GLP-1RA, glucagon-like peptide 1 receptor agonist; HITECH, Health Information Technology for Economic and Clinical Health; PCMH, patient-centered medical home; SGLT2i, sodium–glucose cotransporter 2 inhibitor. Adapted from ref. .

FIGURE 2

Treatment of older U.S. adults (≥65 years of age) with diabetes with an A1C <7% across health status categories. There was no statistical difference in type of treatment across health status categories among these adults (P = 0.43). The number of U.S. adults corresponding to older adults with diabetes with an A1C <7% in each health status category is indicated in millions of people. Reprinted with permission from Lipska et al. (40). ©2015 American Medical Association. All rights reserved.

FIGURE 3

Word cloud representation of feedback from the 2018 therapeutic inertia summit. Participants were asked to list the top three words that describe potential solutions to therapeutic inertia. The size of the words indicates the relative frequency with which they were mentioned (54).

FIGURE 4

Framework for the ADA’s 3-year OTI campaign.

FIGURE 5

The OTI Initiative’s action teams and their priorities.