Diabetes and Therapeutic Inertia

Topic Suggestion

1. What is the decision or change you are facing or struggling with where a summary of the evidence would be helpful?

Given the complex nature of diabetes clinical and self-management, people with diabetes often face something called clinical or therapeutic inertia. Therapeutic inertia occurs when individuals do not intensify or change their treatment protocols despite not achieving their A1C goal. Delaying appropriate treatment can lead to an increase in diabetes-related complications. There are many factors that contribute to therapeutic inertia including challenges with navigating the health system, provider/patient interactions, and the feelings and perceptions of the person with diabetes seeking care.

The [redacted: organization name] is interested to understand if there is a decrease in therapeutic inertia when an individual works with a diabetes educator. Diabetes educators can assist the person with diabetes in navigating the health system; they can serve as a liaison or advocate with other health care providers; and they can help to address concerns by the person with diabetes and support person-centered problem-solving of issues that arise. The diabetes educator can inform and empower the person with diabetes to address the multi-factorial challenges that contribute to therapeutic inertia.

We are interested in the outcomes (specifically decreased therapeutic inertia defined as improved A1C, time in range, reduction in complications, reduction in costs) for people with diabetes working with a diabetes educator.

References:

https://www.diabeteseducator.org/living-with-diabetes/how-a-diabetes-educator-can-help-you

https://www.diabeteseducator.org/research/value-of-diabetes-education

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502982/

https://professional.diabetes.org/meeting/other/overcoming-therapeutic-inertia

2. Why are you struggling with this issue?

There have been advancements made in diabetes technology, medications, education, and other interventions in the last 20 years; however, according to the American Diabetes Association, the average A1C for a person with diabetes has not changed. In fact, we have seen an increase in the number of individuals with an A1C over percent.

The services of diabetes educators are vastly underutilized. For example, diabetes self-management training has been a covered benefit under Medicare for over 15 years. Despite the availability of this benefit, a recent study found only five percent of Medicare beneficiaries with newly diagnosed diabetes used these services.

Diabetes educators are uniquely trained to address many of the factors that contribute to therapeutic inertia (health literacy challenges, concerns over weight gain, medications risks, etc), yet again the services are underutilized.

Studies suggest gaps in what a person with diabetes is willing to do to reduce A1C and their physician’s perspective of what that individual would be willing to do.

Patient data indicates that within one year of a diabetes diagnosis, less than 50% of patients are still taking the prescribed medication.

In 2017 $327 billion was spent on treatment of people with diagnosed diabetes ($237 direct medical costs and $90 million reduced productivity

An evidence report would be helpful to bring attention to this issue and the available interventions. Reducing therapeutic inertia and increasing access to diabetes educators will require reaching referring providers, coverage support from payers, and a reduction in some of the systemic barriers that exist for people with diabetes.

References:

https://professional.diabetes.org/meeting/other/overcoming-therapeutic-inertia

https://www.ncbi.nlm.nih.gov/pubmed/25616412

https://professional.diabetes.org/meeting/other/overcoming-therapeutic-inertia

https://www.diabeteseducator.org/docs/default-source/practice/practice-resources/position-statements/aade7-self-care-behaviors-position-statement.pdf?sfvrsn=6

3. What do you want to see changed? How will you know that your issue is improving or has been addressed?

• Improved A1C (glycemic control, time in range) for people with diabetes
• Reduction in financial and human costs of diabetes
• Physician practice, hospitals, and health systems embedding diabetes educators within the diabetes care team.
• Barriers to accessing diabetes education services are reduced, i.e. reducing barriers to accessing Medicare benefit and increased utilization of services under Medicare
• Increase in models of care delivery that support diabetes education services, i.e. widely adopted practice guidelines that include referral to a diabetes educator, improved payer policies surrounding coverage for these services, tracking of outcomes related to these interventions.
• Improved outcomes for the person with diabetes

4. When do you need the evidence report?

Tue, 06/30/2020

5. What will you do with the evidence report?

We envision using this evidence report in a number of different ways. As mentioned, the diabetes community has come together to address this issue and this evidence report would provide guidance on a potential solution related to therapeutic inertia. This would help to inform practice guidelines. [redacted: organization name] would engage in outreach to the larger diabetes health care team, e.g. referring providers, primary care providers, specialists, like endocrinologists, nurses, hospital staff, diabetes educators, etc. to share this evidence report. We would begin this outreach as soon as the report was received and use this information in our publications and in discussions at our annual conference (August 2020). We would also share this report with patient advocacy groups representing people with diabetes, as well as payers, including Medicare.

There are ongoing efforts within the diabetes community to look at therapeutic inertia. We would look to this evidence report to inform some of those discussions. We would propose a date of June 30, 2020, though we would be open to a later date if this evidence report necessitated more time.

(Optional) About You

What is your role or perspective?

Health care provider

May we contact you if we have questions about your nomination?

Yes

Title

Director of Advocacy