Research Database
Overcoming therapeutic inertia among adults recently diagnosed with Type 2 Diabetes
Lisa K, MD, PhD
Institution:
Kaiser Permanente Northern California
Grant Number:
12-21-OTI-02
Type of Grant:
Clinical
Diabetes Type:
Type 2 Diabetes
Therapeutic Goal:
Manage Diabetes
Project Date:
-
Project Status:
completed

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.

Research Profile

What area of diabetes research does your project cover? What role will this particular project play in preventing, treating and/or curing diabetes?

The goal of this research project is to study therapeutic inertia, a slow response by the care team to adjusting a patient’s treatment regimen if the patient’s treatment goals are not being met. More specifically, this study will help us to better understand how we can overcome barriers to treatment intensification (adding more needed treatment) that exist soon after a person is diagnosed with diabetes.

If a person with diabetes were to ask you how your project will help them in the future, how would you respond?

We now know that it is very important to have good blood sugars soon after a diagnosis with diabetes, in order to prevent long-term diabetes complications from developing, like kidney disease, eye disease, nerve problems, and heart problems. We want to find strategies for doctors and other care team members to help a person with diabetes get their blood sugars controlled quickly.

Why important for you, personally, to become involved in diabetes research? What role will this award play?

I am passionate about diabetes care and have spent the past 20 years taking care of patients with diabetes and thinking about how to make that care better. As the clinical leader for diabetes for Northern California at Kaiser Permanente, I lead a regional diabetes team. The goal of my team is to come up with better ways to help all 350,000 of our patients with diabetes in Northern California to achieve their goals. While we have designed a powerful system to support and empower our patients with diabetes, we have identified early therapeutic inertia to be a weak point in the system, when patients may fall through the cracks. This award directly relates to that problem and will enable us to better understand how to address and fix that problem.

In what direction do you see the future of diabetes research going?

I believe that the future of diabetes research will involve the exploration of systems that make diabetes care more personal and, thereby, enable better care. For example, we will learn how to better identify people with diabetes who are at risk for certain complications, and we will build warning systems into the medical record to call those higher-risk patients to the attention providers. I also believe that diabetes research will involve further exploration of wearable technology, to better understand how diabetes technology can improve the patient’s experience with his or her disease, and improve the care team’s ability to interact with the patient in a useful manner.