Therapeutic inertia: An age old problem with a 21st century solution

Type 2 diabetes, which accounts for 90 percent of all people with diabetes, is characterized by insulin resistance and resulting irregular glycemic levels. This progressive and chronic condition can lead to disorders of the circulatory, nervous, and immune systems if left untreated, or mistreated. While there are many reasons why diabetes therapy may fail, therapeutic inertia is an overwhelmingly common one. 

Therapeutic inertia is defined as "the failure to initiate or intensify therapy in a timely manner according to evidence-based clinical guidelines.” Recent studies show it can take up to seven years to adjust a patient’s treatment as needed, resulting in years-long gaps in therapy.

Despite a wealth of advanced pharmaceuticals, innovative treatments, and diabetes research, up to 50 percent of those with type 2 diabetes are affected by the phenomenon. 

The root of the problem

Healthcare providers are prescribing unnecessary medications based on a detrimental one-size-fits-all approach. This reality underscores the need for accurate and intensive patient monitoring, medication reconciliation, in depth post-hospital follow ups, and comprehensive, tailored transitions of care programs. 

Diabetes therapy consists of managing target glycemic goals, measured by the levels of glycated hemoglobin in the blood. Most people with diabetes have a goal of 7 percent or less. There are two main reasons for ineffective glycemic control: the patient’s inability to adhere to medications or therapeutic inertia. Therapeutic inertia can be caused by the physician, the patient, or in some cases, both. In specific instances, the health care system, diabetes medical devices, and producers of antihyperglycemic therapies can play a role.

The presence of diabetes therapeutic inertia has been documented for over 10 years and has been detected at all stages of treatment intensification, from the first oral antihyperglycemic drug to the initiation of insulin. The widespread prevalence of therapeutic inertia is one of the contributors to fatal diabetes, which is currently the 8th leading cause of death. 

The effective management of type 2 diabetes requires timely, evidence-based, and accurate control of hyperglycemia. It is clear to see that current diabetes therapy is not fulfilling those requirements. 

Much of these inadequacies take place during transitions of care. Thirty four percent of newly prescribed medications are filled only once, when patients are discharged from the hospital, and then never again. One year after discharge, only 52 percent of patients who started oral medications and 61 percent of patients who started insulin were still taking those drugs. 

In many instances, intensifying glucose-lowering therapy does not improve glycemic control, but rather exposes patients to preventable harm caused by hypoglycemia occurring immediately after discharge.

With today’s advancements in both technology and medicine, there is simply no reason why therapeutic inertia should worsen a manageable and preventable disease.

Moving forward

Due to its overwhelming prevalence, some may believe diabetes therapeutic inertia cannot be prevented. Current diabetes therapy simply needs to leverage modern day technology to address barriers and develop solutions. From health informatics systems to patient monitoring, technology is known to provide earlier diagnosis, more personalized treatments, and faster response times.

Therapeutic inertia is often caused by healthcare providers over or underestimating care, avoiding intensification, or a lack of time or materials needed to appropriately assess patient needs. The implementation of clinical decision support systems and patient monitoring devices entirely removes this barrier. Clinical decision support systems can recommend the best treatment plan for patients and through this, turn any non-expert physician to an expert one.

Data centric systems ensure that healthcare providers are equipped with adequate patient information, resulting in timely and personalized treatments. 

It is important to remember that therapeutic inertia is not only caused by the healthcare providers, sometimes patients are at fault. The inability to follow dietary restrictions, low health literacy, and a general lack of understanding of diabetes and its complications are cited reasons. Fear of needles and anxiety over self-administered treatments may also play a role.

Telecommunication software must be implemented to foster adequate patient-provider communication, especially for those in developing nations. Telecommunications will enable patients to reach healthcare experts at any point in treatment. Such systems will help patients understand the benefits and risks of care options, their test results, the trajectory of their therapy, as well as greater diabetes education. Patients, as much as doctors, need to be fully involved in the decision-making process.

Patients and providers need access to adequate resources, independent of one another, in order to tackle therapeutic inertia effectively. 

Therapeutic inertia can occur at any stage of diabetes treatment, caused by any of the involved parties. Due to the pervasive nature of the phenomenon, technology needs to be implemented at all stages to ensure consistency, accuracy, and uniform treatment. The healthcare system must be proactive in adopting modern solutions to solve this age-old problem. 

About Author

Eran Atlas co-founded DreaMed Diabetes in 2014 with the goal of improving diabetes care with the use of Technology and Information Management after 7 years of developing the technology in Schneider Children's Medical Center of Israel. The group’s first mission involved the development of an artificial pancreas system - the Holy Grail technology for type 1 diabetes.