Therapeutic inertia: a retrospective examination of inpatient management for type 2 diabetes mellitus at a South African regional hospital during a singular hospitalisation

Abstract

Background: Therapeutic inertia (TI), the clinicians’ hesitancy to either instigate or escalate therapeutic measures despite clinical evidence, has been identified as a significant hindrance in achieving ideal glycaemic management in type 2 diabetes mellitus (T2DM) patients globally, including in South Africa.

Objective: This research purposed to quantify the prevalence of TI in relation to long-term insulin initiation and intensification within  inpatients during a single admission at a regional-level public hospital in South Africa.

Methods: A retrospective analysis of 300 consecutive inpatient admissions to Harry Gwala Regional Hospital from 28 May 2022 was  conducted.

Results: From the 300 charts identified, 46 were deemed ineligible, leaving 254 for comprehensive assessment. TI was detected in 107  instances (42%), with 73 (68%) of these incidences pertinent to long-term insulin commencement or dosage adjustment during that  admission. A younger demographic was the sole discernible protective factor against TI (p = 0.035). 

Conclusions: The prevalence of TI  among T2DM inpatients during a single admission within a KwaZulu Natal public institution is significant, mirroring figures from global  studies. Most of this inertia is affiliated with insulin-based strategies, resonating with global patterns. Advanced investigations are  imperative to pinpoint specific impediments and strategize countermeasures against TI in such an environment as well as in general.