Therapeutic Inertia Quantification in Diabetes Care: A Narrative Review and Synthesis

Purpose: Therapeutic inertia, which refers to the failure to adjust therapy despite suboptimal glycemic control, is a growing concern. This phenomenon is associated with significant adverse health consequences and reflects the gap between population health goals and patient outcomes. Current research lacks harmonized and effective ways to measure therapeutic inertia, posing significant challenges to addressing this issue in diabetes care. This review aimed to summarize the approaches used to quantify therapeutic inertia in diabetes care, with the goal of improving clinical management and patient outcomes. Methods: A narrative review was conducted to identify relevant articles through a search of MEDLINE (PubMed), Embase, and Web of Science databases from their inception until August 2024, employing search terms related to therapeutic inertia, quantification, and diabetes care . We included all articles that focused on quantifying therapeutic inertia in diabetes care. Quantification methods were summarized with respect to key aspects of formula, scoring, validation, advantages, and limitations. Findings: Four approaches for quantifying therapeutic inertia were identified from the retrieved articles. However, these methods have several limitations that have led to the development of a therapeutic inertia index. The primary goal of the index as a quality measure is to describe healthcare providers' practices and establish a connection between the implemented process measures and key glycemic outcomes. Three commonly used therapeutic inertia indices have been reported in the literature: the norm-based method, standard-based method (SBM), and American Diabetes Association method. Implications: There is a need to standardize therapeutic inertia measurement approaches and develop comprehensive interventions to enhance the management of diabetes.