ArticleBMJ open quality2025
Overcoming therapeutic inertia in primary care: a multisite quality initiative to increase guideline-based prescribing for patients with diabetes.
Article in BMJ open quality, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Low uptake and disparities in therapeutic inertia of cardiorenal protective diabetes medications for patients with type 2 diabetes and above-target hemoglobin A1c.BMJ open diabetes research & care · 2026Article
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3 authors.
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Abstract
backgroundTherapeutic inertia (TI), the failure to intensify or de-intensify treatment when appropriate, is a contributor to poor guideline adherence in diabetes treatment, including the suboptimal use of sodium-glucose cotransporter 2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs).
methodsWe developed a multifaceted improvement initiative targeting TI at four academic primary care practices, aiming to increase rates of SGLT-2i and GLP-1RA use for patients with type 2 diabetes (T2DM). Prescribing trends for GLP-1RAs, SGLT-2is, sulfonylureas and insulin were compiled quarterly over a 12-month baseline period and 12-month intervention period and analysed using interrupted time series analyses. Providers completed a brief questionnaire assessing project feasibility and acceptability.
resultsGLP-1RA prescribing showed an upward trend during both the baseline and intervention periods (+0.70% vs +0.87% per quarter; p=0.14 for difference) and increased significantly in the first intervention quarter (+1.73%; p=0.003). SGLT-2i prescribing was static during the baseline period, showed an upward trend during the intervention (0.0% vs +0.43% per quarter; p=0.05 for difference) and increased significantly in the first intervention quarter (+1.0%; p=0.03). In those prescribed a GLP-1RA or an SGLT-2i, sulfonylurea prescribing dropped significantly after intervention (-2.0% per quarter; p=0.02). Insulin prescribing rates did not change throughout the study period. There was no significant change in haemoglobin A1c among patients newly prescribed a GLP-1RA and/or an SGLT-2i during the intervention period (7.3% ±1.5% baseline vs 7.2% ±1.4% intervention period, p=0.23). Most providers indicated that they had prescribed (90%) and were more likely to prescribe (81%) GLP-1RAs and/or SGLT-2is in the future because of their participation.
conclusionsA quality improvement initiative targeting drivers of TI was associated with increased rates of guideline-based medication prescribing for primary care patients with diabetes and may be applied to other conditions in which TI limits care optimisation or guideline adherence.
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