Research Description

Many people with diabetes do not achieve the recommended blood sugar treatment targets that help decrease the risk of diabetes-related complications, like heart attacks and strokes. One reason blood sugar targets are often not achieved is therapeutic inertia. Therapeutic inertia is the failure to start or increase a type 2 diabetes treatment when it is indicated. One common example of therapeutic inertia is the under-prescribing of the medication metformin. Despite being the initial treatment recommended for patients with type 2 diabetes, many patients are not started on this medication after they are diagnosed. This is problematic since starting metformin increases the likelihood that a patient’s blood sugars will be at recommended levels sooner following the diagnosis. Better control of blood sugar levels early following the diagnosis has been found to have beneficial health effects that last for years after the diagnosis. Given this lasting benefit, care strategies that can increase the prescribing of metformin to newly diagnosed patients can potentially have long term health benefits. Prior research has found that care that includes support from non-physician clinicians (pharmacists and nurses) and technology (electronic alerts) can help overcome therapeutic inertia in type 2 diabetes. Care for patients with type 2 diabetes within Kaiser Permanente Northern California (KPNC), a large healthcare system, already includes non-physician clinicians and uses technology-based tools. However, metformin remains under-prescribed among newly diagnosed KPNC members. To address these shortcomings in care, our research study will examine whether proactive outreach by non-physician clinicians can increase metformin treatment and improve blood sugar levels among KPNC members with newly diagnosed diabetes. We will randomly assign KPNC primary care practices to one of three groups: 1) Continue current type 2 diabetes care, 2) primary care physicians in the practice will receive education about how to address therapeutic inertia, and 3) primary care physicians in the practice will receive education plus their patients will have a telemedicine visit with a non-physician clinician to discuss metformin treatment. We will enroll 600 patients (n=200 in each of the 3 groups). The enrolled patients will have recently diagnosed type 2 diabetes and will not be taking metformin. We will then examine differences in blood sugar levels between the three groups six months after the start of the study. The results of this study will provide information on whether these strategies (physician education and support from non-physician clinicians) can effectively address therapeutic inertia and improve type 2 diabetes care for newly diagnosed patients. Results from this study will support a future, larger study to evaluate the impact of these strategies on improving early type 2 diabetes care in other healthcare systems.