Therapeutic Inertia in Glycemic Management: A Hidden Driver of Poor Diabetes Control and Suboptimal Outcomes: Findings from a Retrospective Cohort Study in Ethiopia

Therapeutic Inertia in Glycemic Management: A Hidden Driver of Poor Diabetes Control and Suboptimal Outcomes: Findings from a Retrospective Cohort Study in Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Therapeutic Inertia in Glycemic Management: A Hidden Driver of Poor Diabetes Control and Suboptimal Outcomes: Findings from a Retrospective Cohort Study in Ethiopia Dawit Alemu Lemma, Lijalem Abera Tema, Muluken Berhanu Mena, Hailu Chare Koyra This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7064316/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 11 You are reading this latest preprint version Abstract This retrospective cohort study investigated the effect of therapeutic inertia on treatment outcomes in patients with type 2 diabetes receiving care at a tertiary hospital in southern Ethiopia. A retrospective cohort study was conducted among 159 adult ambulatory type 2 diabetic patients between June 2020 and 2023. We collected the data from medical records and used EpiData version 4.6 for data entry and SPSS version 25 for analysis. Independent sample t tests, Fisher’s exact tests and chi-square tests were used for data analysis as appropriate. To assess the effect of therapeutic inertia on diabetic treatment outcomes, we applied a Cox proportional hazard model. A p value of less than 0.05 was considered statistically significant. In this study, we reviewed the medical records of type 2 diabetic patients. Poor treatment outcomes were common in the therapeutic inertia group (68.63%). There was a statistically significant difference between groups in the type of physician managing the patients (p = 0.01). Furthermore, the presence of comorbidities (p = 0.024), the mean fasting plasma glucose level (p = 0.01), neuropathy (p = 0.02) and nephropathy (p = 0.011) were significantly associated with therapeutic inertia. The therapeutic inertia exposure group was significantly associated with an increased risk of poor treatment outcomes, with an adjusted HR of 1.927 (95% CI: 1.201–3.092, p = 0.007). Our study revealed that therapeutic inertia worsened diabetic treatment outcomes among type 2 diabetes patients. This underlines that healthcare providers should prioritize proactive management, such as regular reassessment of treatment efficacy and prompt adjustment of therapies, to improve patient outcomes. Health sciences/Diseases Health sciences/Endocrinology Health sciences/Health care Health sciences/Medical research Therapeutic inertia treatment intensification type 2 diabetes treatment outcomes. *Dawit Alemu Lemma and Hailu Chare Koyra contributed equally to this work Background Diabetes mellitus (DM) is a group of chronic metabolic disorders. The characteristic feature of DM is hyperglycemia, which can lead to long-term microvascular and neuropathic complications and is an important contributor to newly diagnosed adult blindness cases, end-stage renal disease, and nontraumatic lower limb amputations. DM additionally contributes to macrovascular complications such as coronary artery disease, peripheral vascular disease, and stroke[1]. The vast majority of diabetic patients fall into one of two broad categories: type 2 diabetes mellitus (T2DM), which is characterized by the presence of insulin resistance with an inadequate compensatory increase in insulin secretion, or type 1 diabetes mellitus, which is caused by an absolute or nearly absolute deficiency of insulin [2]. The prevalence of type 2 diabetes (T2DM) is expected to reach 7079 people per 100,000 by 2030, with a disability-adjusted life years (DALYs) change of 1.86% yearly, demonstrating an ongoing increase in cases across all regions of the world and adding to the growing global burden of diabetes mellitus. Rising prevalence patterns in low-income nations are worrying [3, 4]. The increasing prevalence of noncommunicable diseases such as diabetes is currently a problem in Ethiopia[5]. According to the World Health Organization (WHO), 3.2% of Ethiopians have diabetes mellitus. According to other studies, the prevalence of diabetes mellitus in Ethiopia ranges between 0.5% and 6.5%[6]. Achieving blood glucose levels within the target range is widely recognized as an important strategy for reducing the risk of the development and progression of type 2 diabetes (T2DM)-related complications[7,8]. The cornerstone of the current strategy for managing T2DM is the United Kingdom Prospective Diabetes Study (UKPDS), which shows that tighter glycemic control is associated with better treatment outcomes and fewer complications [9, 10]. The American Association of Diabetes (ADA) and the European Association for the Study of Diabetes (EASD) both agree that the target value of HbA1c that we should strive for in treating the majority of patients should be ≤ 7% [10, 11]. For some people, a tighter target of 6.5% would be appropriate if it could be achieved without resulting in significant adverse effects, including hypoglycemia. These patients may be younger, have a longer expected life expectancy, have had diabetes for a shorter time, be receiving only metformin or lifestyle changes, or have no significant comorbidities [12]. Less stringent targets, such as 8%, may be appropriate for older individuals who have had diabetes for a long time, have experienced severe hypoglycemia in the past, or have numerous serious comorbidities [12]. To prevent the onset and progression of chronic complications, tight glycemic control is essential. Stepwise intensification of antidiabetic medication is also widely recommended [13, 14]. Regrettably, it is very challenging to meet the objectives of the guidelines in routine clinical practice, despite individualizing treatment and clear recommendations. There are many reasons for this situation, one of which can be covered by the term “therapeutic inertia” [15]. Therapeutic inertia is the delay in initiating or intensifying therapy when it is appropriate to do so, despite the glycemic target goals not being met [16, 17]. The word "inertia" generally has a negative connotation, suggesting that the physician is entirely responsible for not giving treatment appropriately or as intensely as they should be to ensure that patients reach guideline-recommended goals. Therapeutic inertia in T2DM patients is a concern, along with antidiabetic medication and other therapies aimed at lowering cardiovascular risk (antihypertensive drugs, lipid-lowering agents, and antiplatelet therapies)[17]. Factors that may contribute to therapeutic inertia can be categorized into three groups. The first group of factors depends on the physician. The second category consists of patient-related factors. The third group focuses on the healthcare system [18]. When considered collectively, a variety of factors at the patient, provider, and health system levels have an impact on the capacity to provide care for diabetic patients. All these factors contribute to the problem of therapeutic inertia, which has major effects on the treatment outcomes of diabetic patients[18]. Despite the growing recognition of therapeutic inertia as a major barring factor for optimal glycemic control. There is limited evidence from low-resource settings, especially the sub-Saharan African region, regarding how therapeutic inertia comes to play and how it affects treatment outcomes. Most available studies have been conducted in high-income countries, whereas very little attention has been given to the contextual challenges faced in Ethiopian healthcare settings. Therefore, this study aims to close this crucial gap in the local and global literature by analyzing the effect of therapeutic inertia on treatment outcomes among patients with type II diabetes attending a tertiary hospital situated in southern Ethiopia. Materials and Methods Study design A hospital-based retrospective cohort study was conducted to assess the effect of therapeutic inertia on treatment outcomes among patients with type 2 diabetes mellitus (T2DM) at Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH). The study covered a three-year period from 2020 to June 2023 and used patient data collected from medical records. This design was chosen to allow for a comparative analysis between patients who experienced therapeutic inertia and those who did not by tracking their treatment progress and outcomes over time. The retrospective cohort approach was particularly suited to this investigation, as it enabled the evaluation of exposure to therapeutic inertia and its potential impact on various clinical outcomes. Within a real-world healthcare setting. Study population The study population comprised adult patients diagnosed with type 2 diabetes mellitus (T2DM) who had regular follow-up visits at Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH) during the study period. Patients were eligible for inclusion if they had a confirmed diagnosis of T2DM, attended routine follow-up appointments, and had complete medical records, including demographic details, laboratory results, and treatment history. Additionally, patients were required to have received diabetes treatment for at least three years prior to data collection. The exclusion criteria included pregnant patients, individuals with diabetes-related complications present at the time of diagnosis or before the assessment of therapeutic inertia, those with a Charlson comorbidity index (CCI) score greater than three, and patients older than 65 years. This carefully defined population ensured the reliability of the data on treatment practices and outcomes in relation to therapeutic inertia. Exposure The primary exposure variable in this study was therapeutic inertia, defined as the failure to initiate or intensify diabetes treatment within three months of identifying suboptimal glycemic control. Patients were categorized into two groups: those with therapeutic inertia (exposed) and those without (nonexposed). Classification was based on a review of patient records against the American Diabetes Association (ADA) 2019 standards for glycemic targets and treatment guidelines. A patient was considered exposed if, despite having a fasting blood glucose (FBG) level above the target range of 80–130 mg/dL, no appropriate changes, such as dose adjustment or the addition of a new glucose-lowering agent, were made within three months. Observable actions indicating no inertia included dose increases, initiation of a new drug class, or sustained glycemic values within the target range. Data collection Data were collected retrospectively from patient medical charts in a structured abstraction format. The tool was designed to capture essential information, including sociodemographic characteristics, clinical history, laboratory values, treatment regimens, and diabetes-related complications. Laboratory results such as fasting blood glucose, HbA1c, and lipid profiles were extracted for each patient at baseline and then at three-month intervals. The presence of therapeutic inertia was determined on the basis of the American Diabetes Association (ADA) 2019 guidelines, specifically, the failure to adjust or intensify therapy within three months of identifying poor glycemic control. Four data collectors, two pharmacists and two nurses, were trained over two days to ensure consistent and accurate extraction of the data. The data collection period spanned from 2020 to June 2023. Sample size calculation The sample size was determined via G*Power software, and a sample size of 159 patients was selected on the basis of a significance level of 5%, power of 80%, and previously estimated therapeutic inertia prevalence of 38.35%[19]. With the additional 10% contingency. From these records, 332 medical records were excluded from the study, and 460 records met the eligibility criteria. For the nontherapeutic inertia (nonexposed) group, 57 records fulfilled the inclusion criteria. For therapeutic inertia (exposed group), we used a systematic random sampling technique in which a total of 102 patient records were gathered. In our study, the exposure-to-nonexposure ratio was nearly 2:1 (1.79:1). For this study, therapeutic inertia was characterized by the proportion of patients with no observable actions on their index date; patients were followed every three months up to 36 months, which was the end of our follow-up. An observable action was defined as either receiving a prescription within three months for a new category of glucose-lowering medications or increasing the doses in addition to the existing baseline medication regimen or not receiving a new prescription but maintaining a measured glycemic value within the target range. We selected a glycemic target of 80–130 mg/dl of mean FBs in this research since individualized targets are not available in our source data and after applying our eligibility criteria, which excludes the majority of patients with fewer and stricter targets. Study Outcomes and Follow-up The outcome of this study was the treatment outcome among patients with type 2 diabetes mellitus, with a specific focus on the impact of therapeutic inertia. Treatment outcomes included measures such as glycemic control over time (based on fasting blood glucose and HbA1c levels), the incidence of diabetes-related complications, Hospitalizations and mortality. Glycemic control was assessed at baseline and at regular three-month intervals throughout the follow-up period. These outcomes provide a comprehensive understanding of how therapeutic inertia influences the effectiveness of diabetes management in the study population. Statistical methods The statistical package for social sciences (SPSS) version 25 was used to analyze the data once they were entered into EpiData V.6. The results are presented as descriptive statistics (frequencies, percentages, means, medians and standard deviations), depending on the type of variables and the normality of the distribution. Therapeutic inertia group characteristics were compared with noninertia group characteristics via an independent t test for continuous variables on the basis of the distribution of data and a chi-square test or Fisher’s exact test for categorical data. P values of less than 0.05 were considered statistically significant. The Cox proportional hazards model was used to determine the effect of therapeutic inertia on diabetic treatment outcomes, and adjustments for confounding variables were also made. Ethical consideration Ethical approval for this study was obtained from the Institutional Review Board (IRB) of Wolaita Sodo University, College of Medicine and Health Sciences. Since the study was retrospective and based on anonymized patient data, the IRB waived the requirement for informed consent. The data supporting the findings of this study are available from the corresponding author upon reasonable request.All methods were performed in accordance with relevant guidelines and regulations. Results Population demographics and baseline characteristics In this study, we assessed the medical records of 159 type 2 diabetic patients; 6.86% were lost to follow-up in the exposed group, 1.75% were lost to follow-up in the nonexposed group, and 7.1% in the exposed group completed the study without treatment intensification. As shown in Table 1 , 61.8% of men and 38.24% of females were in the therapeutic inertia-exposed group. The percentage of participants who lived in urban areas (69.62%) was greater in the therapeutic inertia-exposed group than in the ruler-exposed group (30.4%), and 16.7% had insurance coverage in the therapeutic inertia-exposed group. The age distribution revealed that 42.2% of the participants in the 40–49 years age group were in the therapeutic inertia group, whereas 2.9% of those in the therapeutic inertia group were in the less than 30 years age group, and 89.22% of those in the therapeutic inertia group were treated by general practitioners, whereas 2.94% of those in the therapeutic inertia group were specialists. Table 1 Sociodemographic and clinical characteristics of the study participants at WSUCSH (n = 159) Characters Category Therapeutic inertia Frequency (%)N = 102 Therapeutic inertia No, frequency (%) N = 57 Age < 30 3(2.9) 3(5.3) 30–39 8(7.84) 7(12.3) 40–49 39(38.24) 21(36.84) 50–59 31(30.4) 13(22.81) ≥ 60 21(20.6) 13(22.81) Gender Male 63(61.8) 31(54.4) Female 39(38.24) 26(45.61) Duration of T2DM < 10 98(96.08) 54(94.76) ≥ 10 4(3.92) 3(5.26) Insurance coverage Yes 17(16.67) 12(21.1) No 85(83.3) 45(78.95) Place of residence Urban 71(69.62) 44(77.2) Rural 31(30.4) 13(22.81) Type of physician General practitioners 91(89.21) 28(49.12) Residents 8(7.84) 4(7.02) Specialists 3(2.94) 25(43.86) Antihypertensive medications ACEIs/ARBs Yes 40(39.22) 40(39.22) No 62(60.78) 33(57.895) CCBs Yes 32(31.37) 16(28.07) No 70(68.63) 41(71.93) Comorbidity Yes 72(70.6) 30(52.6) No 30(29.41) 27(51.9) Antiplatelet/anticoagulant Yes 23(22.6) 34(59.65) No 79(77.45) 44(40.36) Statin use Yes 68(66.67) 29(50.88) No 34(33.33) 28(49.12) Baseline sociodemographic characteristics of the participants in the therapeutic inertia and no therapeutic inertia groups We compared therapeutic inertia (exposed) group baseline characteristics to noninertia group characteristics via an independent t test for continuous variables on the basis of the distribution of data and a chi-square test or Fisher’s exact test for categorical data. As demonstrated in Table 2, there were no statistically significant differences in sex distribution (p = 0.364) or age (p = 0.708). There was no significant difference between the groups in terms of T2DM duration or insurance coverage (p = 0.702 and p = 0.492, respectively). A statistically significant difference was shown between the types of physicians (p = 0.001). Table 2 Comparison of the baseline sociodemographic characteristics of patients in the therapeutic inertia and no therapeutic inertia groups at WSUCSH between June 2020 and 2023 (n = 159). Variables Category Total Therapeutic inertia No-Therapeutic inertia Variables Gender Male 94 63 31 0.364 Female 65 39 26 Age < 30 6 3 3 0.708 30–39 15 8 7 40–49 60 39 50–59 44 31 13 ≥ 60 34 21 13 Duration of T2DM < 10 152 98 54 0.702** ≥ 10 7 4 3 Insurance coverage Yes 29 17 12 0.492 No 130 85 45 Type of physician General practitioners 119 91 28 0.001* Residents 12 8 4 Specialists 28 3 25 Frequencies are used to characterize categorical variables. ** For categorical variables, Fisher’s exact test was used. * p value < 0.05. Comparison of the baseline clinical characteristics of patients in the therapeutic inertia and no therapeutic inertia groups As illustrated in Table 3, the presence of comorbidities (p = 0.024) and the mean fasting glucose level (p = 0.001) were significantly different between the groups. Neuropathy and nephropathy were significantly associated (p = 0.02, p = 0.011) with therapeutic inertia. There was no statistically significant difference in the CCI score, systolic or diastolic blood pressure, or incidence of cardiovascular disease between the groups (p = 0.933, p = 0.093, p = 0.400, p = 0.723). Table 3 Comparison of the baseline clinical characteristics of patients in the therapeutic inertia and no therapeutic inertia groups at WSUCSH between June 2020 and 2023 (n = 159) Variables Category Total Therapeutic inertia No-Therapeutic inertia Variables Comorbidity Yes 102 72 30 0.024* No 57 30 27 Hypertension Yes 6 3 3 0.722 No 64 40 24 Dyslipidemia Yes 8 4 4 0.459** No 151 98 53 CKD Yes 21 13 8 0.818 No 138 89 49 Charlson comorbidity index score 1 44 28 16 0.933 2 115 74 41 Fasting blood sugar mean ± SD (mg/dL) 159.42 ± 48.45 174.56 ± 53.36 132.314 ± 17.911 0.001* Blood pressure Systolic blood pressure (mean ± SD) 135.08 ± 7.60 135.84 ± 8.12 133.72 ± 6.422 0.093 Diastolic blood pressure (mean ± SD) 81.99 ± 4.17 82.198 ± 4.177 81.615 ± 4.181 0.400 Neuropathy Yes 49 40 9 0.020* No 110 62 48 Nephropathy Yes 41 33 8 0.011* No 118 69 49 Retinopathy Yes 28 21 7 0. 187 No 131 81 50 Cardiovascular disease Yes 23 14 9 0.723 No 136 88 48 Continuous variables are expressed as the mean ± standard deviation. Frequencies are used to characterize categorical variables. Independent t tests were used for normally distributed and continuous variables. ** For categorical variables, Fisher’s exact test was used. * p value < 0.05. Mean ± SD; mean ± standard deviation. Baseline treatment characteristics of patients in the therapeutic inertia and no therapeutic inertia groups As shown in Table 4, there were no significant differences in the use of antidiabitic medications between the groups (P value = 0.253). We assessed the use of antihypertensive and lipid-lowering medications and detected no significant differences in the utilization of ACEIs/ARBs (P value = 0.722), CCBs (P value = 0.664) or statins (P value = 0.050). Table 4 Treatment characteristics of patients compared between the therapeutic inertia group and the no therapeutic inertia group at WSUCSH between June 2020 and 2023 (n = 159). Variables Category Total Therapeutic inertia No-Therapeutic inertia Variables Types of antidiabitic medications Metformin 25 13 12 0.253** Glibenclamide 1 0 1 Glibenclamide + Metformin 96 61 35 Metformin + insulin 35 27 8 Glibenclamide + Metformin + insulin 1 0 1 Number of medications Mean ± SD 3.07 ± 1.131 3.16 ± 1.167 3.07 ± 1.131 0.192 Antihypertensive medications ACEIs/ARBs Yes 40 24 0.722 No 62 33 CCBS Yes 32 16 0.664 No 70 41 Antiplatelet/anticoagulant Yes 36 23 13 0.970 No 123 79 44 Statin Yes 97 68 29 0.050 No 62 34 28 ** For categorical variables, Fisher’s exact test was used. * P value < 0.05. Independent t tests were used for normally distributed and continuous variables. Cox regression analysis of the effects of therapeutic inertia on diabetic treatment outcomes among type 2 diabetic patients We conducted a bivariable Cox regression analysis to identify candidate variables for multivariable analysis, as shown in Table 5. Treatment inertia (exposed) was significantly associated with poor treatment outcome, with a CHR of 1.917 (95% CI: 1.249–2.943, P = 0.003). Additionally, age categories, the use of lipid-lowering agents, and the number of medications used were included in the multivariable analysis. According to the multivariable analysis of these factors, the therapeutic inertia-exposed group had a 92.7% greater risk of having poor treatment outcomes than did the nonexposed group. The adjusted hazard ratio (AHR) was 1.927 (95% CI 1.201–3.092, p = 0.007). Table 5 Multivariable Cox regression analysis of the effects of therapeutic inertia among type 2 diabetic patients at WSUCSH (n = 159). Variables Category Diabetic treatment outcome CHR(95% CI) AHR(95% CI) Variables Poor Censored Exposure status Exposed 70 32 1.917 (1.249–2.943) 1.927 (1.201–3.092) 0.007** Non-exposed 33 24 Age < 30 3 3 30–39 8 7 3.527 (0.842–14.780) 4.140 (0.804–21.305) 0.505 40–49 44 16 2.65 (0.622–11.290) 3.798 (0.848–17.023) 0.089 50–59 26 18 2.994 (0.699–12.817) 3.444 (0.744–15.930) 0.081 ≥ 60 22 12 3.92 (0.815–18.856) 3.317 (0.734–14.999) 0.114 Use of lipid lowering agent Yes 62 35 1.379 (0.920–2.067) 1.262 (0.787–2.024) 0.335 No 41 21 Number of medication One 10 2 0.240 Two 15 15 2.713 (0.594–12.397) 2.555 (0.512–12.745) 0.253 Three 53 22 1.436 (0.327-6.300) 1.320 (0.284–6.143) 0.724 Four 19 7 1.929 (0.468–7.948) 1.658 (0.390–7.049) 0.493 Five 4 5 1.867 (0.429–8.121) 2.216 (0.490-10.029) 0.302 Others 2 5 0.889 (0.161–4.901) 0.712 (0.122–4.153) 0.706 ** P value < 0.05. Discussion We conducted a study on therapeutic inertia and its effect on treatment outcomes among type 2 diabetes mellitus patients. Our findings revealed the effects of therapeutic inertia on the treatment outcomes of diabetic patients, including glycemic control, diabetic ketoacidosis (DKA), neuropathy, nephropathy, retinopathy, diabetic foot ulcer, metabolic control, cardiovascular disease (CVD), death, referral, and hospitalization, and we compared the therapeutic inertia effects between the two groups with poor and good treatment outcomes. In our study, the average fasting blood sugar (FBS) level among patients with therapeutic inertia was 174.56 ± 53.36 mg/dL. In contrast, a study conducted on diabetic patients with therapeutic inertia in Cameroon reported an average FBS level of 200 ± 108 mg/dL[20]. The discrepancy in these results could be because our study excluded patients who were only dependent on insulin. Both studies, however, indicated elevated FBS levels; specifically, our findings showed that patients experiencing therapeutic inertia had a mean FBS level of 174.56 ± 53.36 mg/dL. This finding suggests an association between delayed treatment intensification and higher FBS levels. In our study, 75.5% of the type of physician involved in the treatment of type 2 diabetic patients were treated by general practitioners, 22.0% by residents, and 2.5% by specialists. A statistically significant difference was observed between the types of physicians and exposure status (p = 0.001). In our study, 89.2% of patients treated by general practitioners were in the therapeutic inertia-exposed group, while residents accounted for 7.8% and specialists accounted for 2.9%. This result contrasts with another study reporting that 32.2% of patients treated by general practitioners, 30.6% treated by residents, and 37.2% treated by specialists were in the therapeutic inertia exposed group[21]. The difference could be because, compared with our patients, most of the patients (43.4%) in the reference study were treated by specialists. The greater percentage of patients in the therapeutic inertia group treated by general practitioners in our study suggests a potential role of physician specializations in influencing the timely intensifications of diabetic treatment. This finding highlights the importance of targeted intervention and further training for general practitioners to address therapeutic inertia effectively. In our study, there were significant differences between groups in the presence of comorbidities, with 70.59% in the therapeutic inertia-exposed group and 29.41% in the nonexposed group (p = 0.024). This result is consistent with a study performed in Serbia, where 76.8% of patients with comorbidities were in the therapeutic inertia group, whereas 62.9% were in the noninertia group (p value = 0.001) [22]. The current study revealed a significant association between therapeutic inertia and nephropathy, with 32.35% in the therapeutic inertia group and 14.04% in the nontherapeutic inertia group (p value = 0.011). Conversely, a study performed in Taiwan reported slightly more nephropathy cases in the nontherapeutic inertia group (10.8%) than in the therapeutic inertia group (7.9%). These differences may be due to our study, which revealed that a greater percentage of patients experienced therapeutic inertia (64.2%). In contrast, a reference study revealed a higher percentage of patients without therapeutic inertia (75.9%)[23]. These differences could also be influenced by differences in the quality of care provided. In our study, a significant association between therapeutic inertia and neuropathy was identified, with 39.22% in the therapeutic inertia group and 15.79% in the nontherapeutic inertia group (p = 0.020); similarly, a study conducted in Cameroon reported that 26% of participants had diabetic nephropathy[24]. In our study, therapeutic inertia was significantly associated with poor treatment outcomes, with an adjusted hazard ratio (AHR) of 1.927 (95% CI 1.201–3.092, p = 0.007) compared with nonexposed individuals. Our results contrast with those of a study performed in the US (AHR, 1.10; 95% CI, 1.03–1.07; P = 0.004) [25]. This discrepancy is most likely due to variations in patient demographics, healthcare professional practices, and healthcare infrastructure between our study and the reference study. However, both studies reported that delayed treatment intensification was associated with poor treatment outcomes. In another study, both our study and the study from Thailand yielded important results concerning the effect of therapeutic inertia on diabetic treatment outcomes among patients with diabetes. In our study, therapeutic inertia was significantly associated with an increased risk of poor treatment outcomes, with an adjusted hazard ratio (HR) of 1.927 (95% CI 1.201–3.092, p = 0.007). This result is consistent with that of the Thailand study, which reported an adjusted HR of 1.51 and a substantial increase in the risk of poor treatment outcomes associated with therapeutic inertia [23]. This study revealed that therapeutic inertia was associated with an increase in the risk of poor treatment outcomes (adjusted HR: 1.927, 95% CI, 1.201–3.092; p = 0.007). In contrast, a US study reported a 19% increase in overall poor diabetic treatment outcomes for patients with delayed treatment intensification for more than two years. This difference could be because the reference study involved only patients who needed insulin treatment intensifications and differences in healthcare systems[26]. Strengths and limitations of the study The strength of this study is that, to the best of our knowledge, it is the first in the country to look at therapeutic inertia and how it affects diabetic treatment outcomes by focusing on therapeutic inertia and its effect on the outcomes of diabetic treatment. This study can provide information for healthcare professionals that could guide them in areas where diabetes care needs to be improved. As a limitation, because our study is retrospective and depends only on available data, it was challenging to control for all the variables, although efforts have been made to account for confounding variables. We also used mean fasting blood sugar instead of HbA1c, which is a well-established measure of consistent glycemia over time. Conclusion In conclusion, the findings of this study showed that diabetic patients exposed to therapeutic inertia had worse treatment outcomes than nonexposed individuals did. The majority of general practitioners were major contributors to therapeutic inertia, indicating the need for more focused interventions and better training. Compared with noninertia, diabetic complications such as nephropathy and neuropathy were significantly associated with therapeutic inertia. Therapeutic inertia was significantly associated with poor treatment outcomes. On the basis of the results of our study, we note the following recommendations. Wolaita Sodo University Comprehensive Specialized Hospital and MOH should implement training programs for general practitioners to improve their practices regarding timely treatment intensifications for type 2 diabetes patients. The hospital’s diabetic care clinic should promote early glycemic control to reduce diabetic complications and poor treatment outcomes. Hospitals should pay attention to early glycemic control so that poor diabetic outcomes can be minimized. For researchers, prospective studies are needed to identify factors contributing to therapeutic inertia, and ongoing nationwide studies are needed for a comprehensive strategy. Declarations Funding This research received no external funding. Author Contribution D.A.L. conceived and designed the study, collected and analyzed the data, and drafted the main manuscript text. H.C.K., and M.B.M. contributed to data interpretation and critically reviewed the manuscript for important intellectual content. L.A. M contributed to clinical data review and helped revise the manuscript. All authors reviewed and approved the final version of the manuscript. Acknowledgement We thank the staff of Wolaita Sodo University Comprehensive Specialized Hospital for their assistance in accessing medical records and supporting the data collection process. 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Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet (London, England). 1998;352(9131):854 − 65. Simon D. Therapeutic inertia in type 2 diabetes: insights from the PANORAMA study in France. Diabetes & metabolism. 2012;38 Suppl 3:S47-52. Lucas Martín AM, Guanyabens E, Zavala-Arauco R, Chamorro J, Granada ML, Mauricio D, et al. Breaking Therapeutic Inertia in Type 2 Diabetes: Active Detection of In-Patient Cases Allows Improvement of Metabolic Control at Midterm. International journal of endocrinology. 2015;2015:381415. Khunti K, Seidu S. Therapeutic Inertia and the Legacy of Dysglycemia on the Microvascular and Macrovascular Complications of Diabetes. Diabetes care. 2019;42(3):349 − 51. Karam SL, Dendy J, Polu S, Blonde L. Overview of Therapeutic Inertia in Diabetes: Prevalence, Causes, and Consequences. Diabetes spectrum : a publication of the American Diabetes Association. 2020;33(1):8–15. Huang LY, Yeh HL, Yang MC, Shau WY, Su S, Lai MS. Therapeutic inertia and intensified treatment in diabetes mellitus prescription patterns: A nationwide population-based study in Taiwan. The Journal of international medical research. 2016;44(6):1263-71. Suinyuy LMC, Fokunang TE, Mesmin D, Ngo NV, Fokunang CN. Evaluation of the Therapeutic Approach and Outcome of Type 2 Diabetes Mellitus Management Strategies in Cameroon. cell.6:16 − 8. Kaewbut P, Kosachunhanun N, Phrommintikul A, Chinwong D, Hall J, Chinwong S. An observational study of clinical inertia among patients with type 2 diabetes mellitus in a tertiary care hospital. Arch Med Sci. 2020;16:3–7. Isajev N, Bjegovic-Mikanovic V, Bukumiric Z, Vrhovac D, Lalic NM. Predictors of Clinical Inertia and Type 2 Diabetes: Assessment of Primary Care Physicians and Their Patients. International journal of environmental research and public health. 2022;19(8). Kaewbut P, Kosachunhanun N, Phrommintikul A, Chinwong D, Hall JJ, Chinwong S. Effect of Clinical Inertia on Diabetes Complications among Individuals with Type 2 Diabetes: A Retrospective Cohort Study. Medicina (Kaunas, Lithuania). 2021;58(1). Suinyuy LMC, Fokunang TE, Mesmin D, Ngo NV, Fokunang CN. Evaluation of the therapeutic approach and outcome of type 2 diabetes mellitus management strategies in Cameroon. Journal of Advances in Medical and Pharmaceutical Sciences. 2019;20(4):1–15. Nichols GA, Romo-LeTourneau V, Vupputuri S, Thomas SM. Delays in anti-hyperglycemic therapy initiation and intensification are associated with cardiovascular events, hospitalizations for heart failure and all-cause mortality. Diabetes, obesity & metabolism. 2019;21(7):1551-7. Matian J, Goldenberg A, McCombs J, Kim R, Xuan S, Choe J, et al. RWD4 Impact of Therapeutic Inertia on Healthcare Outcomes for Patients with Type 2 Diabetes Mellitus. Value in Health. 2022;25(7):S576. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 30 Mar, 2026 Reviews received at journal 29 Mar, 2026 Reviewers agreed at journal 29 Mar, 2026 Reviews received at journal 10 Jan, 2026 Reviewers agreed at journal 09 Jan, 2026 Reviewers agreed at journal 13 Nov, 2025 Reviewers invited by journal 11 Nov, 2025 Editor assigned by journal 11 Nov, 2025 Editor invited by journal 17 Jul, 2025 Submission checks completed at journal 14 Jul, 2025 First submitted to journal 14 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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10:08:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1132168,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7064316/v1/3c7a54e0-5b9a-438c-bf5a-da7314e32a3e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Therapeutic Inertia in Glycemic Management: A Hidden Driver of Poor Diabetes Control and Suboptimal Outcomes: Findings from a Retrospective Cohort Study in Ethiopia","fulltext":[{"header":"Background","content":"\u003cp\u003eDiabetes mellitus (DM) is a group of chronic metabolic disorders. The characteristic feature of DM is hyperglycemia, which can lead to long-term microvascular and neuropathic complications and is an important contributor to newly diagnosed adult blindness cases, end-stage renal disease, and nontraumatic lower limb amputations. DM additionally contributes to macrovascular complications such as coronary artery disease, peripheral vascular disease, and stroke[1]. The vast majority of diabetic patients fall into one of two broad categories: type 2 diabetes mellitus (T2DM), which is characterized by the presence of insulin resistance with an inadequate compensatory increase in insulin secretion, or type 1 diabetes mellitus, which is caused by an absolute or nearly absolute deficiency of insulin [2]. The prevalence of type 2 diabetes (T2DM) is expected to reach 7079 people per 100,000 by 2030, with a disability-adjusted life years (DALYs) change of 1.86% yearly, demonstrating an ongoing increase in cases across all regions of the world and adding to the growing global burden of diabetes mellitus. Rising prevalence patterns in low-income nations are worrying [3, 4].\u003c/p\u003e\u003cp\u003eThe increasing prevalence of noncommunicable diseases such as diabetes is currently a problem in Ethiopia[5]. According to the World Health Organization (WHO), 3.2% of Ethiopians have diabetes mellitus. According to other studies, the prevalence of diabetes mellitus in Ethiopia ranges between 0.5% and 6.5%[6]. Achieving blood glucose levels within the target range is widely recognized as an important strategy for reducing the risk of the development and progression of type 2 diabetes (T2DM)-related complications[7,8]. The cornerstone of the current strategy for managing T2DM is the United Kingdom Prospective Diabetes Study (UKPDS), which shows that tighter glycemic control is associated with better treatment outcomes and fewer complications [9, 10].\u003c/p\u003e\u003cp\u003eThe American Association of Diabetes (ADA) and the European Association for the Study of Diabetes (EASD) both agree that the target value of HbA1c that we should strive for in treating the majority of patients should be \u0026le;\u0026thinsp;7% [10, 11]. For some people, a tighter target of 6.5% would be appropriate if it could be achieved without resulting in significant adverse effects, including hypoglycemia. These patients may be younger, have a longer expected life expectancy, have had diabetes for a shorter time, be receiving only metformin or lifestyle changes, or have no significant comorbidities [12]. Less stringent targets, such as 8%, may be appropriate for older individuals who have had diabetes for a long time, have experienced severe hypoglycemia in the past, or have numerous serious comorbidities [12]. To prevent the onset and progression of chronic complications, tight glycemic control is essential. Stepwise intensification of antidiabetic medication is also widely recommended [13, 14]. Regrettably, it is very challenging to meet the objectives of the guidelines in routine clinical practice, despite individualizing treatment and clear recommendations. There are many reasons for this situation, one of which can be covered by the term \u0026ldquo;therapeutic inertia\u0026rdquo; [15].\u003c/p\u003e\u003cp\u003eTherapeutic inertia is the delay in initiating or intensifying therapy when it is appropriate to do so, despite the glycemic target goals not being met [16, 17]. The word \"inertia\" generally has a negative connotation, suggesting that the physician is entirely responsible for not giving treatment appropriately or as intensely as they should be to ensure that patients reach guideline-recommended goals. Therapeutic inertia in T2DM patients is a concern, along with antidiabetic medication and other therapies aimed at lowering cardiovascular risk (antihypertensive drugs, lipid-lowering agents, and antiplatelet therapies)[17]. Factors that may contribute to therapeutic inertia can be categorized into three groups. The first group of factors depends on the physician. The second category consists of patient-related factors. The third group focuses on the healthcare system [18].\u003c/p\u003e\u003cp\u003eWhen considered collectively, a variety of factors at the patient, provider, and health system levels have an impact on the capacity to provide care for diabetic patients. All these factors contribute to the problem of therapeutic inertia, which has major effects on the treatment outcomes of diabetic patients[18]. Despite the growing recognition of therapeutic inertia as a major barring factor for optimal glycemic control. There is limited evidence from low-resource settings, especially the sub-Saharan African region, regarding how therapeutic inertia comes to play and how it affects treatment outcomes. Most available studies have been conducted in high-income countries, whereas very little attention has been given to the contextual challenges faced in Ethiopian healthcare settings. Therefore, this study aims to close this crucial gap in the local and global literature by analyzing the effect of therapeutic inertia on treatment outcomes among patients with type II diabetes attending a tertiary hospital situated in southern Ethiopia.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cb\u003eStudy design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA hospital-based retrospective cohort study was conducted to assess the effect of therapeutic inertia on treatment outcomes among patients with type 2 diabetes mellitus (T2DM) at Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH). The study covered a three-year period from 2020 to June 2023 and used patient data collected from medical records. This design was chosen to allow for a comparative analysis between patients who experienced therapeutic inertia and those who did not by tracking their treatment progress and outcomes over time. The retrospective cohort approach was particularly suited to this investigation, as it enabled the evaluation of exposure to therapeutic inertia and its potential impact on various clinical outcomes.\u003c/p\u003e\u003cp\u003eWithin a real-world healthcare setting.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy population\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study population comprised adult patients diagnosed with type 2 diabetes mellitus (T2DM) who had regular follow-up visits at Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH) during the study period. Patients were eligible for inclusion if they had a confirmed diagnosis of T2DM, attended routine follow-up appointments, and had complete medical records, including demographic details, laboratory results, and treatment history. Additionally, patients were required to have received diabetes treatment for at least three years prior to data collection. The exclusion criteria included pregnant patients, individuals with diabetes-related complications present at the time of diagnosis or before the assessment of therapeutic inertia, those with a Charlson comorbidity index (CCI) score greater than three, and patients older than 65 years. This carefully defined population ensured the reliability of the data on treatment practices and outcomes in relation to therapeutic inertia.\u003c/p\u003e\u003cp\u003e\u003cb\u003eExposure\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe primary exposure variable in this study was therapeutic inertia, defined as the failure to initiate or intensify diabetes treatment within three months of identifying suboptimal glycemic control. Patients were categorized into two groups: those with therapeutic inertia (exposed) and those without (nonexposed). Classification was based on a review of patient records against the American Diabetes Association (ADA) 2019 standards for glycemic targets and treatment guidelines. A patient was considered exposed if, despite having a fasting blood glucose (FBG) level above the target range of 80\u0026ndash;130 mg/dL, no appropriate changes, such as dose adjustment or the addition of a new glucose-lowering agent, were made within three months. Observable actions indicating no inertia included dose increases, initiation of a new drug class, or sustained glycemic values within the target range.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eData were collected retrospectively from patient medical charts in a structured abstraction format. The tool was designed to capture essential information, including sociodemographic characteristics, clinical history, laboratory values, treatment regimens, and diabetes-related complications. Laboratory results such as fasting blood glucose, HbA1c, and lipid profiles were extracted for each patient at baseline and then at three-month intervals. The presence of therapeutic inertia was determined on the basis of the American Diabetes Association (ADA) 2019 guidelines, specifically, the failure to adjust or intensify therapy within three months of identifying poor glycemic control. Four data collectors, two pharmacists and two nurses, were trained over two days to ensure consistent and accurate extraction of the data. The data collection period spanned from 2020 to June 2023.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample size calculation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe sample size was determined via G*Power software, and a sample size of 159 patients was selected on the basis of a significance level of 5%, power of 80%, and previously estimated therapeutic inertia prevalence of 38.35%[19]. With the additional 10% contingency. From these records, 332 medical records were excluded from the study, and 460\u003c/p\u003e\u003cp\u003erecords met the eligibility criteria. For the nontherapeutic inertia (nonexposed) group, 57 records fulfilled the inclusion criteria. For therapeutic inertia (exposed group), we used a systematic random sampling technique in which a total of 102 patient records were gathered. In our study, the exposure-to-nonexposure ratio was nearly 2:1 (1.79:1).\u003c/p\u003e\u003cp\u003eFor this study, therapeutic inertia was characterized by the proportion of patients with no observable actions on their index date; patients were followed every three months up to 36 months, which was the end of our follow-up. An observable action was defined as either receiving a prescription within three months for a new category of glucose-lowering medications or increasing the doses in addition to the existing baseline medication regimen or not receiving a new prescription but maintaining a measured glycemic value within the target range.\u003c/p\u003e\u003cp\u003eWe selected a glycemic target of 80\u0026ndash;130 mg/dl of mean FBs in this research since individualized targets are not available in our source data and after applying our eligibility criteria, which excludes the majority of patients with fewer and stricter targets.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Outcomes and Follow-up\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe outcome of this study was the treatment outcome among patients with type 2 diabetes mellitus, with a specific focus on the impact of therapeutic inertia. Treatment outcomes included measures such as glycemic control over time (based on fasting blood glucose and HbA1c levels), the incidence of diabetes-related complications,\u003c/p\u003e\u003cp\u003eHospitalizations and mortality. Glycemic control was assessed at baseline and at regular three-month intervals throughout the follow-up period. These outcomes provide a comprehensive understanding of how therapeutic inertia influences the effectiveness of diabetes management in the study population.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatistical methods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe statistical package for social sciences (SPSS) version 25 was used to analyze the data once they were entered into EpiData V.6. The results are presented as descriptive statistics (frequencies, percentages, means, medians and standard deviations), depending on the type of variables and the normality of the distribution. Therapeutic inertia group characteristics were compared with noninertia group characteristics via an independent t test for continuous variables on the basis of the distribution of data and a chi-square test or Fisher\u0026rsquo;s exact test for categorical data. P values of less than 0.05 were considered statistically significant. The Cox proportional hazards model was used to determine the effect of therapeutic inertia on diabetic treatment outcomes, and adjustments for confounding variables were also made.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical consideration\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003e for this study was obtained from the Institutional Review Board (IRB) of Wolaita Sodo University, College of Medicine and Health Sciences. Since the study was retrospective and based on anonymized patient data, the IRB waived the requirement for informed consent. The data supporting the findings of this study are available from the corresponding author upon reasonable request.All methods were performed in accordance with relevant guidelines and regulations.\u003c/p\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePopulation demographics and baseline characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, we assessed the medical records of 159 type 2 diabetic patients; 6.86% were lost to follow-up in the exposed group, 1.75% were lost to follow-up in the nonexposed group, and 7.1% in the exposed group completed the study without treatment intensification. As shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, 61.8% of men and 38.24% of females were in the therapeutic inertia-exposed group. The percentage of participants who lived in urban areas (69.62%) was greater in the therapeutic inertia-exposed group than in the ruler-exposed group (30.4%), and 16.7% had insurance coverage in the therapeutic inertia-exposed group. The age distribution revealed that 42.2% of the participants in the 40\u0026ndash;49 years age group were in the therapeutic inertia group, whereas 2.9% of those in the therapeutic inertia group were in the less than 30 years age group, and 89.22% of those in the therapeutic inertia group were treated by general practitioners, whereas 2.94% of those in the therapeutic inertia group were specialists.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSociodemographic and clinical characteristics of the study participants at WSUCSH (n\u0026thinsp;=\u0026thinsp;159)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCharacters\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCategory\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTherapeutic inertia Frequency (%)N\u0026thinsp;=\u0026thinsp;102\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTherapeutic inertia\u003c/p\u003e\n\u003cp\u003eNo, frequency (%)\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;57\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(2.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(5.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(7.84)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7(12.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39(38.24)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21(36.84)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50\u0026ndash;59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31(30.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(22.81)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21(20.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(22.81)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63(61.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31(54.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39(38.24)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26(45.61)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eDuration of T2DM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e98(96.08)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54(94.76)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(3.92)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(5.26)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eInsurance coverage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17(16.67)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12(21.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e85(83.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45(78.95)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePlace of residence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUrban\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e71(69.62)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44(77.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRural\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31(30.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(22.81)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eType of physician\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGeneral practitioners\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e91(89.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28(49.12)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eResidents\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(7.84)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(7.02)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSpecialists\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(2.94)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25(43.86)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"6\" align=\"left\"\u003e\n\u003cp\u003eAntihypertensive medications\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eACEIs/ARBs\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40(39.22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40(39.22)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62(60.78)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33(57.895)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eCCBs\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32(31.37)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16(28.07)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70(68.63)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41(71.93)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eComorbidity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72(70.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30(52.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30(29.41)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27(51.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAntiplatelet/anticoagulant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23(22.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34(59.65)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e79(77.45)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44(40.36)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eStatin use\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68(66.67)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29(50.88)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34(33.33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28(49.12)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eBaseline sociodemographic characteristics of the participants in the therapeutic inertia and no therapeutic inertia groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe compared therapeutic inertia (exposed) group baseline characteristics to noninertia group characteristics via an independent t test for continuous variables on the basis of the distribution of data and a chi-square test or Fisher\u0026rsquo;s exact test for categorical data. As demonstrated in Table\u0026nbsp;2, there were no statistically significant differences in sex distribution (p\u0026thinsp;=\u0026thinsp;0.364) or age (p\u0026thinsp;=\u0026thinsp;0.708). There was no significant difference between the groups in terms of T2DM duration or insurance coverage (p\u0026thinsp;=\u0026thinsp;0.702 and p\u0026thinsp;=\u0026thinsp;0.492, respectively). A statistically significant difference was shown between the types of physicians (p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComparison of the baseline sociodemographic characteristics of patients in the therapeutic inertia and no therapeutic inertia groups at WSUCSH between June 2020 and 2023 (n\u0026thinsp;=\u0026thinsp;159).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Taba\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCategory\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTherapeutic inertia\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNo-Therapeutic inertia\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.364\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"5\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.708\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50\u0026ndash;59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eDuration of T2DM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e152\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.702**\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eInsurance coverage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.492\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e130\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eType of physician\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGeneral practitioners\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e119\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.001*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eResidents\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSpecialists\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eFrequencies are used to characterize categorical variables. ** For categorical variables, Fisher\u0026rsquo;s exact test was used. * p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of the baseline clinical characteristics of patients in the therapeutic inertia and no therapeutic inertia groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs illustrated in Table\u0026nbsp;3, the presence of comorbidities (p\u0026thinsp;=\u0026thinsp;0.024) and the mean fasting glucose level (p\u0026thinsp;=\u0026thinsp;0.001) were significantly different between the groups. Neuropathy and nephropathy were significantly associated (p\u0026thinsp;=\u0026thinsp;0.02, p\u0026thinsp;=\u0026thinsp;0.011) with therapeutic inertia. There was no statistically significant difference in the CCI score, systolic or diastolic blood pressure, or incidence of cardiovascular disease between the groups (p\u0026thinsp;=\u0026thinsp;0.933, p\u0026thinsp;=\u0026thinsp;0.093, p\u0026thinsp;=\u0026thinsp;0.400, p\u0026thinsp;=\u0026thinsp;0.723).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;3\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComparison of the baseline clinical characteristics of patients in the therapeutic inertia and no therapeutic inertia groups at WSUCSH between June 2020 and 2023 (n\u0026thinsp;=\u0026thinsp;159)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tabb\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCategory\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTherapeutic inertia\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNo-Therapeutic inertia\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eComorbidity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e102\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.024*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eHypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.722\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eDyslipidemia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.459**\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e151\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCKD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.818\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e138\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCharlson comorbidity index score\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.933\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e115\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFasting blood sugar\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (mg/dL)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e159.42\u0026thinsp;\u0026plusmn;\u0026thinsp;48.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e174.56\u0026thinsp;\u0026plusmn;\u0026thinsp;53.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e132.314\u0026thinsp;\u0026plusmn;\u0026thinsp;17.911\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.001*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBlood pressure\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSystolic blood pressure (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e135.08\u0026thinsp;\u0026plusmn;\u0026thinsp;7.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e135.84\u0026thinsp;\u0026plusmn;\u0026thinsp;8.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e133.72\u0026thinsp;\u0026plusmn;\u0026thinsp;6.422\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.093\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiastolic blood pressure (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e81.99\u0026thinsp;\u0026plusmn;\u0026thinsp;4.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e82.198\u0026thinsp;\u0026plusmn;\u0026thinsp;4.177\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e81.615\u0026thinsp;\u0026plusmn;\u0026thinsp;4.181\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.400\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eNeuropathy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.020*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eNephropathy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.011*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e118\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eRetinopathy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0. 187\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCardiovascular disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.723\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e136\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eContinuous variables are expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Frequencies are used to characterize categorical variables. Independent t tests were used for normally distributed and continuous variables. ** For categorical variables, Fisher\u0026rsquo;s exact test was used. * p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD; mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBaseline treatment characteristics of patients in the therapeutic inertia and no therapeutic inertia groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Table\u0026nbsp;4, there were no significant differences in the use of antidiabitic medications between the groups (P value\u0026thinsp;=\u0026thinsp;0.253). We assessed the use of antihypertensive and lipid-lowering medications and detected no significant differences in the utilization of ACEIs/ARBs (P value\u0026thinsp;=\u0026thinsp;0.722), CCBs (P value\u0026thinsp;=\u0026thinsp;0.664) or statins (P value\u0026thinsp;=\u0026thinsp;0.050).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;4\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTreatment characteristics of patients compared between the therapeutic inertia group and the no therapeutic inertia group at WSUCSH between June 2020 and 2023 (n\u0026thinsp;=\u0026thinsp;159).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tabc\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCategory\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTherapeutic inertia\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNo-Therapeutic inertia\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eTypes of antidiabitic medications\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMetformin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e0.253**\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGlibenclamide\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGlibenclamide\u0026thinsp;+\u0026thinsp;Metformin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMetformin\u0026thinsp;+\u0026thinsp;insulin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGlibenclamide\u0026thinsp;+\u0026thinsp;Metformin\u0026thinsp;+\u0026thinsp;insulin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNumber of medications\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.167\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.192\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eAntihypertensive medications\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eACEIs/ARBs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.722\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCCBS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.664\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAntiplatelet/anticoagulant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.970\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e123\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eStatin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e97\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.050\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e** For categorical variables, Fisher\u0026rsquo;s exact test was used. * P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Independent t tests were used for normally distributed and continuous variables.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCox regression analysis of the effects of therapeutic inertia on diabetic treatment outcomes among type 2 diabetic patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a bivariable Cox regression analysis to identify candidate variables for multivariable analysis, as shown in Table\u0026nbsp;5. Treatment inertia (exposed) was significantly associated with poor treatment outcome, with a CHR of 1.917 (95% CI: 1.249\u0026ndash;2.943, P\u0026thinsp;=\u0026thinsp;0.003). Additionally, age categories, the use of lipid-lowering agents, and the number of medications used were included in the multivariable analysis. According to the multivariable analysis of these factors, the therapeutic inertia-exposed group had a 92.7% greater risk of having poor treatment outcomes than did the nonexposed group. The adjusted hazard ratio (AHR) was 1.927 (95% CI 1.201\u0026ndash;3.092, p\u0026thinsp;=\u0026thinsp;0.007).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;5\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultivariable Cox regression analysis of the effects of therapeutic inertia among type 2 diabetic patients at WSUCSH (n\u0026thinsp;=\u0026thinsp;159).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tabd\" border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCategory\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eDiabetic treatment outcome\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCHR(95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAHR(95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePoor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCensored\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eExposure status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExposed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.917 (1.249\u0026ndash;2.943)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.927 (1.201\u0026ndash;3.092)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.007**\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-exposed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.527 (0.842\u0026ndash;14.780)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.140 (0.804\u0026ndash;21.305)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.505\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.65 (0.622\u0026ndash;11.290)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.798 (0.848\u0026ndash;17.023)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.089\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50\u0026ndash;59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.994 (0.699\u0026ndash;12.817)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.444 (0.744\u0026ndash;15.930)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.081\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.92 (0.815\u0026ndash;18.856)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.317 (0.734\u0026ndash;14.999)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.114\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eUse of lipid lowering agent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.379 (0.920\u0026ndash;2.067)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.262 (0.787\u0026ndash;2.024)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.335\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"6\" align=\"left\"\u003e\n\u003cp\u003eNumber of medication\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOne\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.240\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTwo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.713 (0.594\u0026ndash;12.397)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.555 (0.512\u0026ndash;12.745)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.253\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eThree\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.436 (0.327-6.300)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.320 (0.284\u0026ndash;6.143)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.724\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFour\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.929 (0.468\u0026ndash;7.948)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.658 (0.390\u0026ndash;7.049)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.493\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.867 (0.429\u0026ndash;8.121)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.216 (0.490-10.029)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.302\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOthers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.889 (0.161\u0026ndash;4.901)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.712 (0.122\u0026ndash;4.153)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.706\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e** P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe conducted a study on therapeutic inertia and its effect on treatment outcomes among type 2 diabetes mellitus patients. Our findings revealed the effects of therapeutic inertia on the treatment outcomes of diabetic patients, including glycemic control, diabetic ketoacidosis (DKA), neuropathy, nephropathy, retinopathy, diabetic foot ulcer, metabolic control, cardiovascular disease (CVD), death, referral, and hospitalization, and we compared the therapeutic inertia effects between the two groups with poor and good treatment outcomes.\u003c/p\u003e\u003cp\u003eIn our study, the average fasting blood sugar (FBS) level among patients with therapeutic inertia was 174.56\u0026thinsp;\u0026plusmn;\u0026thinsp;53.36 mg/dL. In contrast, a study conducted on diabetic patients with therapeutic inertia in Cameroon reported an average FBS level of 200\u0026thinsp;\u0026plusmn;\u0026thinsp;108 mg/dL[20]. The discrepancy in these results could be because our study excluded patients who were only dependent on insulin. Both studies, however, indicated elevated FBS levels; specifically, our findings showed that patients experiencing therapeutic inertia had a mean FBS level of 174.56\u0026thinsp;\u0026plusmn;\u0026thinsp;53.36 mg/dL. This finding suggests an association between delayed treatment intensification and higher FBS levels.\u003c/p\u003e\u003cp\u003eIn our study, 75.5% of the type of physician involved in the treatment of type 2 diabetic patients were treated by general practitioners, 22.0% by residents, and 2.5% by specialists. A statistically significant difference was observed between the types of physicians and exposure status (p\u0026thinsp;=\u0026thinsp;0.001). In our study, 89.2% of patients treated by general practitioners were in the therapeutic inertia-exposed group, while residents accounted for 7.8% and specialists accounted for 2.9%. This result contrasts with another study reporting that 32.2% of patients treated by general practitioners, 30.6% treated by residents, and 37.2% treated by specialists were in the therapeutic inertia exposed group[21]. The difference could be because, compared with our patients, most of the patients (43.4%) in the reference study were treated by specialists.\u003c/p\u003e\u003cp\u003eThe greater percentage of patients in the therapeutic inertia group treated by general practitioners in our study suggests a potential role of physician specializations in influencing the timely intensifications of diabetic treatment. This finding highlights the importance of targeted intervention and further training for general practitioners to address therapeutic inertia effectively.\u003c/p\u003e\u003cp\u003eIn our study, there were significant differences between groups in the presence of comorbidities, with 70.59% in the therapeutic inertia-exposed group and 29.41% in the nonexposed group (p\u0026thinsp;=\u0026thinsp;0.024). This result is consistent with a study performed in Serbia, where 76.8% of patients with comorbidities were in the therapeutic inertia group, whereas 62.9% were in the noninertia group (p value\u0026thinsp;=\u0026thinsp;0.001) [22].\u003c/p\u003e\u003cp\u003eThe current study revealed a significant association between therapeutic inertia and nephropathy, with 32.35% in the therapeutic inertia group and 14.04% in the nontherapeutic inertia group (p value\u0026thinsp;=\u0026thinsp;0.011). Conversely, a study performed in Taiwan reported slightly more nephropathy cases in the nontherapeutic inertia group (10.8%) than in the therapeutic inertia group (7.9%). These differences may be due to our study, which revealed that a greater percentage of patients experienced therapeutic inertia (64.2%). In contrast, a reference study revealed a higher percentage of patients without therapeutic inertia (75.9%)[23]. These differences could also be influenced by differences in the quality of care provided.\u003c/p\u003e\u003cp\u003eIn our study, a significant association between therapeutic inertia and neuropathy was identified, with 39.22% in the therapeutic inertia group and 15.79% in the nontherapeutic inertia group (p\u0026thinsp;=\u0026thinsp;0.020); similarly, a study conducted in Cameroon reported that 26% of participants had diabetic nephropathy[24].\u003c/p\u003e\u003cp\u003eIn our study, therapeutic inertia was significantly associated with poor treatment outcomes, with an adjusted hazard ratio (AHR) of 1.927 (95% CI 1.201\u0026ndash;3.092, p\u0026thinsp;=\u0026thinsp;0.007) compared with nonexposed individuals. Our results contrast with those of a study performed in the US (AHR, 1.10; 95% CI, 1.03\u0026ndash;1.07; P\u0026thinsp;=\u0026thinsp;0.004) [25]. This discrepancy is most likely due to variations in patient demographics, healthcare professional practices, and healthcare infrastructure between our study and the reference study. However, both studies reported that delayed treatment intensification was associated with poor treatment outcomes.\u003c/p\u003e\u003cp\u003eIn another study, both our study and the study from Thailand yielded important results concerning the effect of therapeutic inertia on diabetic treatment outcomes among patients with diabetes. In our study, therapeutic inertia was significantly associated with an increased risk of poor treatment outcomes, with an adjusted hazard ratio (HR) of 1.927 (95% CI 1.201\u0026ndash;3.092, p\u0026thinsp;=\u0026thinsp;0.007). This result is consistent with that of the Thailand study, which reported an adjusted HR of 1.51 and a substantial increase in the risk of poor treatment outcomes associated with therapeutic inertia [23].\u003c/p\u003e\u003cp\u003eThis study revealed that therapeutic inertia was associated with an increase in the risk of poor treatment outcomes (adjusted HR: 1.927, 95% CI, 1.201\u0026ndash;3.092; p\u0026thinsp;=\u0026thinsp;0.007). In contrast, a US study reported a 19% increase in overall poor diabetic treatment outcomes for patients with delayed treatment intensification for more than two years. This difference could be because the reference study involved only patients who needed insulin treatment intensifications and differences in healthcare systems[26].\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrengths and limitations of the study\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe strength of this study is that, to the best of our knowledge, it is the first in the country to look at therapeutic inertia and how it affects diabetic treatment outcomes by focusing on therapeutic inertia and its effect on the outcomes of diabetic treatment. This study can provide information for healthcare professionals that could guide them in areas where diabetes care needs to be improved. As a limitation, because our study is retrospective and depends only on available data, it was challenging to control for all the variables, although efforts have been made to account for confounding variables. We also used mean fasting blood sugar instead of HbA1c, which is a well-established measure of consistent glycemia over time.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the findings of this study showed that diabetic patients exposed to therapeutic inertia had worse treatment outcomes than nonexposed individuals did. The majority of general practitioners were major contributors to therapeutic inertia, indicating the need for more focused interventions and better training. Compared with noninertia, diabetic complications such as nephropathy and neuropathy were significantly associated with therapeutic inertia. Therapeutic inertia was significantly associated with poor treatment outcomes. On the basis of the results of our study, we note the following recommendations. Wolaita Sodo University Comprehensive Specialized Hospital and MOH should implement training programs for general practitioners to improve their practices regarding timely treatment intensifications for type 2 diabetes patients. The hospital\u0026rsquo;s diabetic care clinic should promote early glycemic control to reduce diabetic complications and poor treatment outcomes. Hospitals should pay attention to early glycemic control so that poor diabetic outcomes can be minimized. For researchers, prospective studies are needed to identify factors contributing to therapeutic inertia, and ongoing nationwide studies are needed for a comprehensive strategy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research received no external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eD.A.L. conceived and designed the study, collected and analyzed the data, and drafted the main manuscript text. H.C.K., and M.B.M. contributed to data interpretation and critically reviewed the manuscript for important intellectual content. L.A. M contributed to clinical data review and helped revise the manuscript. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe thank the staff of Wolaita Sodo University Comprehensive Specialized Hospital for their assistance in accessing medical records and supporting the data collection process.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to patient confidentiality and institutional data use agreements but are available from the corresponding author upon on request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Banday MZ, Sameer AS, Nissar S. Pathophysiology of diabetes: An overview. 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Evaluation of the Therapeutic Approach and Outcome of Type 2 Diabetes Mellitus Management Strategies in Cameroon. cell.6:16\u0026thinsp;\u0026minus;\u0026thinsp;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Kaewbut P, Kosachunhanun N, Phrommintikul A, Chinwong D, Hall J, Chinwong S. An observational study of clinical inertia among patients with type 2 diabetes mellitus in a tertiary care hospital. Arch Med Sci. 2020;16:3\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Isajev N, Bjegovic-Mikanovic V, Bukumiric Z, Vrhovac D, Lalic NM. Predictors of Clinical Inertia and Type 2 Diabetes: Assessment of Primary Care Physicians and Their Patients. International journal of environmental research and public health. 2022;19(8).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Kaewbut P, Kosachunhanun N, Phrommintikul A, Chinwong D, Hall JJ, Chinwong S. Effect of Clinical Inertia on Diabetes Complications among Individuals with Type 2 Diabetes: A Retrospective Cohort Study. Medicina (Kaunas, Lithuania). 2021;58(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Suinyuy LMC, Fokunang TE, Mesmin D, Ngo NV, Fokunang CN. Evaluation of the therapeutic approach and outcome of type 2 diabetes mellitus management strategies in Cameroon. Journal of Advances in Medical and Pharmaceutical Sciences. 2019;20(4):1\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Nichols GA, Romo-LeTourneau V, Vupputuri S, Thomas SM. Delays in anti-hyperglycemic therapy initiation and intensification are associated with cardiovascular events, hospitalizations for heart failure and all-cause mortality. Diabetes, obesity \u0026amp; metabolism. 2019;21(7):1551-7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Matian J, Goldenberg A, McCombs J, Kim R, Xuan S, Choe J, et al. RWD4 Impact of Therapeutic Inertia on Healthcare Outcomes for Patients with Type 2 Diabetes Mellitus. Value in Health. 2022;25(7):S576.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Therapeutic inertia, treatment intensification, type 2 diabetes, treatment outcomes. *Dawit Alemu Lemma and Hailu Chare Koyra contributed equally to this work","lastPublishedDoi":"10.21203/rs.3.rs-7064316/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7064316/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis retrospective cohort study investigated the effect of therapeutic inertia on treatment outcomes in patients with type 2 diabetes receiving care at a tertiary hospital in southern Ethiopia. A retrospective cohort study was conducted among 159 adult ambulatory type 2 diabetic patients between June 2020 and 2023. We collected the data from medical records and used EpiData version 4.6 for data entry and SPSS version 25 for analysis. Independent sample t tests, Fisher’s exact tests and chi-square tests were used for data analysis as appropriate. To assess the effect of therapeutic inertia on diabetic treatment outcomes, we applied a Cox proportional hazard model. A p value of less than 0.05 was considered statistically significant. In this study, we reviewed the medical records of type 2 diabetic patients. Poor treatment outcomes were common in the therapeutic inertia group (68.63%). There was a statistically significant difference between groups in the type of physician managing the patients (p = 0.01). Furthermore, the presence of comorbidities (p = 0.024), the mean fasting plasma glucose level (p = 0.01), neuropathy (p = 0.02) and nephropathy (p = 0.011) were significantly associated with therapeutic inertia. The therapeutic inertia exposure group was significantly associated with an increased risk of poor treatment outcomes, with an adjusted HR of 1.927 (95% CI: 1.201–3.092, p = 0.007). Our study revealed that therapeutic inertia worsened diabetic treatment outcomes among type 2 diabetes patients. This underlines that healthcare providers should prioritize proactive management, such as regular reassessment of treatment efficacy and prompt adjustment of therapies, to improve patient outcomes.\u003c/p\u003e","manuscriptTitle":"Therapeutic Inertia in Glycemic Management: A Hidden Driver of Poor Diabetes Control and Suboptimal Outcomes: Findings from a Retrospective Cohort Study in Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-22 00:28:54","doi":"10.21203/rs.3.rs-7064316/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-30T04:58:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-29T14:26:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214636769870079701323137204519507764151","date":"2026-03-29T14:21:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-10T09:56:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"307555057369280269428538852617727162904","date":"2026-01-09T18:07:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328988704122149112119405060993263271899","date":"2025-11-13T20:02:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-11T13:26:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-11T10:54:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-17T08:44:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-14T09:35:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-07-14T07:17:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4a6f8049-c3a6-47c0-8efc-64595c95e289","owner":[],"postedDate":"November 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":58084707,"name":"Health sciences/Diseases"},{"id":58084708,"name":"Health sciences/Endocrinology"},{"id":58084709,"name":"Health sciences/Health care"},{"id":58084710,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-03-30T05:09:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-22 00:28:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7064316","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7064316","identity":"rs-7064316","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}