The term “therapeutic inertia” refers to the failure to advance therapy or to de-intensify therapy when appropriate (1). This is a critical issue for us and for our patients, as we often fail to use recommended therapies in a timely manner or to optimize interventions to achieve desired outcomes. This concern applies to both intensification of therapy and deintensification, when appropriate.
In 2019, I wrote an editorial describing a November 2018 meeting that initiated a 3-year American Diabetes Association Overcoming Therapeutic Inertia (OTI) initiative to develop a strategic plan and pragmatic solutions to address therapeutic inertia (2). The OTI project worked across the entire health care continuum to assist physicians, nurse practitioners, physician associates, pharmacists, dietitians, and diabetes care and education specialists to more effectively partner with their patients to implement the most effective care strategies for proper glycemic control. The plan was to address therapeutic inertia, thereby driving timely treatment optimization and improving care plan adherence.
To further the goals of the project, the OTI initiative developed a patient engagement toolkit, offering a plethora of resources, including:
Critical Conversations for Overcoming Therapeutic Inertia Framework, a roadmap for quickly surfacing and addressing issues that can lead to unnecessary therapeutic delays
Overcoming Resistance to Therapy Intensification in Type 2 Diabetes, a patient self-assessment tool and conversation guide
Your Type 2 Diabetes Treatment: Get Ready for Your Visit, a pre-visit patient questionnaire
Your Diabetes Care and Management Plan Summary, a helpful summary of patients’ test results and targets, current medications, lifestyle recommendations, and specialist referrals
Your Diabetes Care and Management Plan, a detailed guide to taking charge of type 2 diabetes and preventing its complications
Diabetes Education Referral Form, for referring patients to diabetes self-management education and support and medical nutrition therapy services
This invaluable toolkit of resources can be downloaded in its entirety from https://therapeuticinertia.diabetes.org/patient-engagement-toolkit. One of the resources within this toolkit, Your Type 2 Diabetes Treatment: Get Ready for Your Visit, has also been adapted as the patient information page in this issue of Clinical Diabetes (p. 581) (3). This questionnaire can facilitate more productive interactions with your patients and provide opportunities to address their goals and any barriers they encounter on their diabetes journey.
Additional OTI resources include fact sheets, webinars, clinical pearls, and a host of other materials that can assist you in developing and implementing strategies to improve your patients’ outcomes.
A great deal of effort has been expended in the development of these OTI resources. However, although many of these tools have been widely disseminated and are now being used in practice, we know that we have still only scratched the surface of meeting the need for guidance and tools to improve the timeliness of our care of people with diabetes.
Please avail yourself of these valuable resources and make your fellow clinicians aware of them as well. Working together, we can make a real difference in addressing the widespread and prevailing inertia that hinders the implementation of best practices in the management of diabetes.
