Missed opportunities in diabetes care: unraveling therapeutic inertia and its predictors in resource-limited settings.

BACKGROUND: Therapeutic inertia the failure to intensify treatment despite persistent hyperglycemia is a major barrier to optimal management of type 2 diabetes, particularly in low-resource settings. METHODS: A hospital-based cross-sectional study was conducted from June 1, 2024, to August 30, 2024. A total of 299 systematically selected patients were included. Data were collected via structured questionnaires and patient medical records. Bivariable and multivariable binary logistic regression analyses were used to identify factors associated with therapeutic inertia. Variables with a p value < 0.25 in the bivariable analysis were included in the multivariable model, and those with a p value < 0.05 were considered statistically significant. RESULTS: Overall, 67.2% of patients experienced therapeutic inertia. Multivariable analysis identified four independent predictors: lack of health insurance reduced the likelihood of treatment intensification (AOR = 0.177; 95% CI: 0.054-0.576; p = 0.004); management by general practitioners doubled the odds of inertia compared with specialist care (AOR = 2.002; 95% CI: 1.017-3.939; p = 0.045); higher baseline fasting plasma glucose was associated with increased odds of inertia (AOR = 1.008; 95% CI: 1.003-1.013; p = 0.003); and limited availability of point-of-care HbA1c testing substantially increased the risk of inertia (AOR = 8.423; 95% CI: 1.889-37.561; p = 0.005). CONCLUSION: Therapeutic inertia is highly prevalent, affecting 67.2% of ambulatory patients with type 2 diabetes at NEMMCSH. This study highlights critical barriers at patient, provider, and system levels. Interventions such as expanding insurance coverage, enhancing provider training and decision support, implementing prompts for elevated glycemia, and integrating point-of-care HbA1c testing are urgently needed to reduce therapeutic inertia and improve glycemic control in resource-constrained settings.