Addressing Therapeutic Inertia in Diabetes Care: Strategies in Resource-Limited Settings

A therapeutic inertia study in Ethiopia found that 67.2% of ambulatory adults with type 2 diabetes experienced therapeutic inertia, revealing a large gap in timely treatment escalation that undermines optimal glycemic control.

Lack of health insurance emerged as a strong predictor of non-intensification; uninsured patients had markedly lower odds of treatment escalation. The authors used multivariable logistic regression on a hospital-based ambulatory cohort to link insurance status with likelihood of intensification, underscoring system-level barriers to timely care.

Availability of point-of-care HbA1c testing was associated with an adjusted odds ratio of 8.4 for same-visit treatment adjustments, using facility-level availability as the unit of analysis. Immediate results enabled clinicians to change medications during the visit and correlated with lower inertia rates in facilities with testing.

Clinician uncertainty and limited follow-up capacity, together with patient-level factors—medication cost, access barriers and competing priorities—were identified as contributors to inertia in this resource-limited setting.