Low uptake and disparities in therapeutic inertia of cardiorenal protective diabetes medications for patients with type 2 diabetes and above-target hemoglobin A1c.

INTRODUCTION: Therapeutic inertia (failure to initiate or intensify therapy when therapeutic goals are unmet) contributes to poor glycemic control and diabetes-related complications. We assessed the extent of therapeutic inertia, defined as a lack of new prescription orders for sodium-glucose cotransporter-2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1RA), among patients with type 2 diabetes and above-target hemoglobin A1c who had clinical indications for use, were not currently using these medications, and had no contraindications. We also examined whether prescribing patterns differed by race and ethnicity. RESEARCH DESIGN AND METHODS: We conducted a retrospective cohort analysis of 2018-2022 electronic health record data. Log-link Poisson generalized estimating equation models estimated relative risks (RR) and assessed predictors of therapeutic inertia and trends over time. RESULTS: Among 10 345 eligible patients (30 740 encounters), 56% were White, 37% Black, 3% Hispanic, 2% Asian, and 2% other races and ethnicities. The rate of new prescribing increased over time but remained low (SGLT2i: 0.9%-4.3%; GLP-1RA: 1.2%-5.2%). After adjusting for sociodemographic, clinical, and service factors, Black patients were less likely than White patients to receive new SGLT2i (RR 0.59, 95% CI 0.42 to 0.82) and GLP-1RA (RR 0.62, 95% CI 0.49 to 0.79) prescriptions; Hispanic patients were less likely to receive new GLP-1RA prescriptions (RR 0.48, 95% CI 0.25 to 0.92). CONCLUSION: Despite compelling indications, initiation of SGLT2i and GLP-1RA remained low overall and was significantly lower among Black and Hispanic patients, underscoring therapeutic inertia as a modifiable barrier to optimal diabetes care.

Duke Scholars

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