(1080) Therapeutic Inertia in Diabetes Care Management: A Retrospective Comparative Study of Specialty Clinics and Standard of Care

Objectives: The primary objective of this study is to compare the proportion of patients with type 2 diabetes mellitus (T2DM) with therapeutic inertia between patients managed by a specialty clinic or standard of care. Type 2 diabetes mellitus is a disease characterized by pancreatic beta-cell dysfunction and is the eighth most common leading cause of death in the United States (US) as of 2021. Approximately 16% of US adults are currently diagnosed with T2DM. Glycemic control is the primary goal of treatment in order to prevent or delay micro- and macro-vascular complications. With the variety of treatment options available today, glycemic control should, theoretically, be easy to obtain. Therapeutic inertia, or the failure to make a therapeutic change when treatment goals are not met, occurs in approximately 30% to 50% of patients with T2DM initiated on basal or basal-bolus insulin. Causes of therapeutic inertia are multifaceted and can be attributed to health-system, healthcare provider, and patient-associated barriers. These barriers include fear of adverse effects, increased complexity of treatment regimens, medication costs, patient health literacy, and patient denial of the seriousness of their disease. Over time, patients with uncontrolled diabetes will experience the deleterious effects of hyperglycemia such as retinopathy, nephropathy, and cardiovascular complications. According to the American Diabetes Association, the best way to circumvent these complications is to achieve and maintain glycemic control. One analysis of diabetes treatment found that approximately half of patients are uncontrolled and of those patients, almost 40% are only treated with a single agent. Therefore, there are multiple opportunities to identify mechanisms to optimize patient care and address barriers to care. One approach to this is through the use of disease-state specific management services.

Methods: This study took place in a single-center, federally qualified health center (FQHC) in the southern US. A retrospective chart review was conducted to evaluate therapeutic inertia in patients with T2DM on basal or basal-bolus insulin during a 30-month period. Therapeutic inertia was defined as a failure to increase the dose of insulin, failure to add bolus insulin to basal regimens, or failure to add an additional glucose-lowering agent. Data was extracted from the electronic medical record to identify patients with uncontrolled T2DM. Electronic records were reviewed by the primary investigator to determine demographic and clinical outcomes information. Patients that met the following criteria were included in the study: 19 years of age and older, uncontrolled T2DM, on basal, bolus, or basal-bolus insulin, and at least two A1c readings during the study period. Uncontrolled T2DM was defined as an A1c greater than seven percent. Patients were excluded if their T2DM was managed by an endocrinologist, they failed to show for three or more routine appointments, or A1C was < 7%. Patients were stratified into three groups based on their diabetes care management approach. The control group was managed by a physician or nurse practitioner. The intervention group was managed in a specialized diabetes clinic run by either a nurse practitioner or pharmacist. Statistical analysis was performed using descriptive statistics and the chi-square test or Fisher’s exact test using IBM® SPSS® Statistics version 29.0.1.0 (2023). Approval for this analysis was obtained through the University’s Institutional Review Board.

Results: Pending; research in progress.

Conclusions: Addressing therapeutic inertia can have significant implications to not only the quality of care a patient receives, but also the prevention or delay of diabetes related complications. The study conclusion is pending; however, it is hypothesized that T2DM care managed in a specialty clinic will have fewer patients experiencing therapeutic inertia compared to the standard of care.