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Special Edition: Disrupting Therapeutic Inertia in Diabetes Management

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This special series of Diabetes Core Update is supported by an independent educational grant from Sanofi.

Despite the development of new technologies, drug therapies, and education programs, the average A1C for a person with diabetes has not changed in the past 20 years. In fact, the number of patients with an A1C over 9% has actually increased. Moreover, less than 20% of patients have lowered their A1C, blood pressure, and LDL cholesterol levels to target ranges. And within one year of diagnosis, less than 50% of patients adhere to their prescription regimens.

There are myriad factors that underlie the lack of progress in improving A1C and other outcomes for patients with diabetes. Therapeutic inertia, which refers to the failure to advance, intensify, or adjust therapy as appropriate, is a major contributor.

Diabetes Core Update explores the multiple facets of therapeutic inertia in this special three-episode series made possible by an independent educational grant from Sanofi. In each episode, Drs. Neil Skolnik and John Russell of Abington Jefferson Health present and discuss the latest clinically relevant articles and information related to the impact of therapeutic inertia, the importance of getting to goal, and the benefits of simultaneous intensification versus sequential treat-to-fail approaches for patients with diabetes.

Please listen to each episode by clicking on the podcast players below or by freely subscribing to Diabetes Core Update via Apple Podcasts, Amazon Music, Spotify, or your preferred podcast platform.

Play Episode

Total Time: 40:05 | File Size: 55.1 MB

In this third and final episode of the Diabetes Core Update series on “Disrupting Therapeutic Inertia in Diabetes Management,” Dr. Neil Skolnik focuses on practical solutions for overcoming therapeutic inertia. To do so, Dr. Skolnik discusses various strategies and approaches with four master physicians, each of whom provide a unique perspective on how to address therapeutic inertia in the treatment of diabetes:


Dr. Eric L. Johnson discusses the importance of understanding and being familiar with the ADA/EASD algorithm for prescribing and adjusting medications, as well as the importance of planning and communicating next steps with patients at each visit.

Dr. William H. Polonsky discusses the importance of creating a sense of urgency around treatment and management, as well as strategies for developing trust with patients in order to guide them to better adherence and diabetes management.

Dr. Pamela R. Kushner discusses the importance of a team approach to managing patients with diabetes, as well as the usefulness of free patient resources that can help patients with diabetes, including ADA’s Living with Type 2 Diabetes program.

Dr. Steven V. Edelman discusses the importance of empathizing with patients, of understanding and acknowledging the difficulties related to managing diabetes, in order to encourage patients to better adhere to their treatment protocols.

This episode concludes the special three-part series on therapeutic inertia. This series is supported by an independent educational grant from Sanofi.

Play Episode

Total Time: 30:10 | File Size: 57.9 MB

In this second episode of a three-part series on “Disrupting Therapeutic Inertia in Diabetes Management,” Drs. John Russell and Neil Skolnik are joined by Dr. Stewart Harris of the Schulich School of Medicine and Dentistry, Western University (Toronto, ON), to discuss the causes and consequences of therapeutic inertia. In so doing, Drs. Russell, Skolnik, and Harris refer to the following publications:


The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes & Aging Study). Laiteerapong N, Ham SA, Gao Y, Moffet HH, Liu JY, Huang ES, Karter AJ. Diabetes Care. 2019 Mar;42(3):416-426. Epub 2018 Aug 13. PMID: 30104301; PMCID: PMC6385699.

Delay in treatment intensification increases the risks of cardiovascular events in patients with type 2 diabetes. Paul SK, Klein K, Thorsted BL, Wolden ML, Khunti K. Cardiovasc Diabetol. 2015 Aug 7;14:100. doi: 10.1186/s12933-015-0260-x. PMID: 26249018; PMCID: PMC4528846.

Therapeutic Inertia in People With Type 2 Diabetes in Primary Care: A Challenge That Just Won't Go Away. Zhu NA, Harris SB. Diabetes Spectr. 2020 Feb;33(1):44-49. doi: 10.2337/ds19-0016. PMID: 32116453; PMCID: PMC7026753.

Person-Centered, Outcomes-Driven Treatment: A New Paradigm for Type 2 Diabetes in Primary Care. Harris SB, Cheng AYY, Davies MJ, Gerstein HC, Green JB, Skolnik N. Arlington (VA): American Diabetes Association; 2020 May. PMID: 32667763.

Play Episode

Total Time: 22:25 | File Size: 43 MB

In this first episode of a three-part series on “Disrupting Therapeutic Inertia in Diabetes Management,” Drs. John Russell and Neil Skolnik examine a case study of a 55-year-old man with type 2 diabetes (3 years duration, A1C 8.2%). In so doing, they review the following six articles that define achievement gaps in reaching A1C goals and the reasons for why those gaps exist:


Achievement of guideline targets for blood pressure, lipid, and glycaemic control in type 2 diabetes: A meta-analysis. Khunti et al. Diabetes Research and Clinical Practice 2018 March; Vol. 137: 137-148.

Evaluation of the Cascade of Diabetes Care in the United States, 2005-2016. Kazemian P, Shebl FM, McCann N, Walensky RP, Wexler DJ. JAMA Intern Med. 2019;179(10):1376–1385. doi:10.1001/jamainternmed.2019.2396

Intensification of Diabetes Therapy and Time Until A1C Goal Attainment Among Patients With Newly Diagnosed Type 2 Diabetes Who Fail Metformin Monotherapy Within a Large Integrated Health System. Pantalone et al. Diabetes Care 2016 Sep; 39(9): 1527-1534.

Clinical Inertia in People With Type 2 Diabetes. Khunti et al. Diabetes Care 2013 Nov; 36(11): 3411-3417.

Understanding the Gap Between Efficacy in Randomized Controlled Trials and Effectiveness in Real-World Use of GLP-1 RA and DPP-4 Therapies in Patients With Type 2 Diabetes. Carls et al. Diabetes Care 2017 Nov; 40(11): 1469-1478.

Achievement of Target A1C <7.0% (<53 mmol/mol) by U.S. Type 2 Diabetes Patients Treated With Basal Insulin in Both Randomized Controlled Trials and Clinical Practice. Blonde et al. Diabetes Spectrum 2019 May; 32(2): 93-103.

In episodes 2 and 3 of this series, Drs. Russell and Skolnik will look at additional causes of therapeutic inertia and solutions for overcoming it. This special three-part series on therapeutic inertia is supported by an independent educational grant from Sanofi.


The American Diabetes Association’s campaign on Overcoming Therapeutic Inertia: Accelerating Diabetes Care for Life includes several resources, including a white paper from the ADA Summit on Therapeutic Inertia and presentation slides from previous workshops, to explore the current state of therapeutic inertia and how to address it in a clinical setting.

Led by Guest Editor Kamlesh Kunti and Editor-in-Chief Curtis Triplitt, the Winter 2020 issue of Diabetes Spectrum includes a special “From Research to Practice” collection on Improving Outcomes of People With Diabetes Through Overcoming Therapeutic Inertia. This collection includes seven articles that examine the prevalence, causes, and consequences of therapeutic inertia and discuss how clinicians, patients, and other stakeholders can address and reduce therapeutic inertia.

Diabetes Core Update is a monthly audio podcast devoted to presenting and discussing the latest clinically relevant articles from ADA’s four scholarly journals: Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Users can freely access previous episodes of Diabetes Core Update here.

For previous episodes, please visit:
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