It’s fair to say that type 2 diabetes management is a daily, multistep process that patients with diabetes must follow to achieve excellent blood glucose control. Then there is the work of the patient’s physician, who must determine the next steps if that control isn’t reached. And we haven’t even mentioned comorbidity management.

A phenomenon known as therapeutic inertia occurs when a patient does not receive the guideline-indicated next steps, even when clinically indicated, which makes optimal management all the more difficult. For at least 20 years, researchers have been trying to figure out why the treatment plans of so many patients with diabetes and metabolic syndrome components stay stuck, sometimes for years.

The data continue to show how difficult good management is.

A 3-year study published in 2025 examined uncontrolled blood pressure (BP) among older adults enrolled in nine Chicago suburb clinics. It found that of 52,750 visits, 33.8% involved uncontrolled BP. Of those, 73.4% met the study’s definition of therapeutic inertia. A similar BP figure was found in a review on clinical inertia many years earlier.

Another 2025 study showed that glycemic control rates dropped from 54.3% in 2023 to 43.5% in 2023. Young adults aged 20-44 years had the largest decline, with glycemic control rates falling from 57.4% to 37.1%.

Barbara Eichorst, MS, RD, vice president of health care programs at the American Diabetes Association, and a certified diabetes care and education specialist, said a major concern associated with therapeutic inertia is that “many people don’t realize that each diabetes medication targets a different physiological pathway. Relying on just one agent may not adequately address the complexity of diabetes management.”

Studies that have proposed ways to overcome inertia include strategies such as overall better communication, more education for both patients and physicians, and increased use of technology. 

Reasons

The reasons for therapeutic inertia and patient medication nonadherence aren’t a mystery; they are well known.

Fear of hypoglycemia among both patients and physicians if insulin is increased? Check. Patients’ lack of understanding that diabetes is a progressive disease, and therefore medication additions and titrations are normal? Check. Primary care physicians (PCPs), who play shortstop in the world of healthcare, are unable to attend to all of a patient’s needs in 20 minutes, and may spend only about an hour a week reading newly published articles? Check.

Then there is mindset, Eichorst said. For clinicians, there can be hesitation to intensify therapy due to concerns about side effects, cost, or adherence. For people with diabetes, there is often an emotional component, such as feelings of guilt, fear, or the belief that adding another medication means they have failed.

Not so, she said. If patients were informed of the pathophysiology of this disease, they would understand “that adding another medication is not a setback — it’s a strategic and natural step in managing their condition effectively.”

Medication adherence is certainly a factor in poor disease management. A 2017 study blamed poor glycemic control on patient behavior. “While poor medication adherence is not a new issue, it has yet to be effectively addressed in clinical practice — often, we suspect, because it goes unrecognized,” the authors said. 

But it’s the physicians who get most of the blame for poor disease management. “[Therapeutic inertia] has a much higher impact on disease control compared to medication adherence, implying disease management strategies should prioritize reducing therapeutic inertia.”

Meeting Pain Points

An interventional study published in October 2025 hits the pain points that underscore therapeutic inertia, said lead author Michael W. Latreille, MD, Department of Medicine, University of Vermont Medical Center, Burlington, Vermont.

Over the course of 2 years, divided into baseline and intervention periods, 43 PCPs in four clinical practices were kept on their collective toes regarding whether, and when, their patients with diabetes were prescribed SGLT2s and/or GLP-1s.

The pain points addressed were:

• Easy access to up-to-date disease education — on prescribing information via podcast and on diabetes management via educational printouts
• A modified electronic health record dashboard to support effective panel management (with human instruction to get the information they need) and to better identify patients with diabetes who were overdue for care or eligible for treatment modification

The physicians also received a step-by-step instruction sheet with screenshots each quarter via email. Prescribing trends for GLP-1s, SGLT2 inhibitors, sulfonylureas, and insulin were compiled quarterly.

“PCPs are notoriously busy, so we tried to think of how we could make things easy for them from as many angles as possible,” said Latreille. “This meant making each aspect highly accessible, from the educational content to the patient lists for panel management.”

In the end, 90% of the trial participants said via a survey that they had prescribed the medications, and 81% would continue to do so.

Why did the intervention work? “Providers like to see the numbers move,” said. “It makes the fruits of our efforts tangible. I think the data that most resonated with providers came in the quarterly updates that we sent out during the intervention. This allowed everyone to see our progress and served as a reminder of what we were doing and why.”

Latreille said his practice has already started on its next kill-the-inertia project: hypertension.

“Compared to a high A1c, it is much easier to ignore an elevated blood pressure reading, call it inaccurate, blame it on the circumstances of the day, chalk it up to whitecoat hypertension, or otherwise kick the can down the road when we have all the information we need to make a decision to intervene. So, I am now constantly thinking about how I can anticipate work through TI [therapeutic inertia] in my own practice and how I can help my colleagues do the same, especially with blood pressure management.”