Examining therapeutic inertia patterns in type 2 diabetes patients with multiple chronic conditions: Time-to-event analysis.

OBJECTIVE: Therapeutic inertia (TI) in type 2 diabetes (T2D)-delayed treatment adjustment despite elevated A1C-is often complicated by multiple chronic conditions (MCC). We examined how clinicians address TI in patients with T2D and MCC and evaluated association with patient, clinic, and neighborhood factors. METHODS: Using electronic health records from two Midwestern U.S. health systems, we identified a retrospective six-year cohort of adults with T2D, MCC, and above-target A1C (>7% [53 mmol/mol] for age < 65; >8% [64 mmol/mol] for age ≥ 65). Time-to-event analyses assessed factors associated with clinicians addressing TI. The event was defined as maintaining TI ≤ 0.5 for two consecutive years indicating prescription changes occurred in more than 50% of opportunities following above-target A1C. Covariates included demographics, comorbidity, insulin use, number of diabetes drug classes, clinic rurality, and neighborhood social deprivation. FINDINGS: A cohort of 18,003 adults met eligibility criteria (mean age 59; 78% White). Among patients with T2D and MCC, clinicians addressed TI in 17% of cases at two-year, 31% at four-year, and 38% at five-year follow-up. Clinicians were more likely to address TI with MCC in patients experiencing greater social deprivation and being prescribed with more diabetes drug classes at baseline (p<0.05). Despite addressing TI, patients aged 18-44 had the worst glycemic control (8.3% [67 mmol/mol]) and high prevalence of depression (82%). CONCLUSION: Therapeutic inertia varied by patient, clinic, and neighborhood factors, emphasizing the need for targeted, multifaceted interventions to reduce TI, especially among populations facing socioeconomic and mental health challenges.