ArticleBMJ open diabetes research & care2026
Low uptake and disparities in therapeutic inertia of cardiorenal protective diabetes medications for patients with type 2 diabetes and above-target hemoglobin A1c.
Article in BMJ open diabetes research & care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionTherapeutic 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
methodsWe 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.
resultsAmong 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).
conclusionDespite 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.
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