New Perspectives on Therapeutic Inertia from Social Media
diaTribe Founder Kelly Close was recently part of an American Diabetes Association (ADA) panel on therapeutic inertia. According to the ADA, therapeutic inertia is “the failure to establish appropriate targets and escalate treatment to achieve treatment goals.” Said differently, therapeutic inertia is part of the reason why advances diabetes medicines, devices, and treatment strategies don’t always translate into better outcomes. Between 2003 and 2014, achievement of individualized targets decreased from 70% to 64%; between 2007 and 2004, the percentage of people with an A1c >9% increased from 13% to 16%.
Here are some of our favorite moments from the panel:
- Kelly Close: “Society can be a bit oblivious to how hard primary care teams are working. From a patient perspective, there is also much obliviousness about science – the science is transformative in diabetes, and there are extensive benefits emerging from diabetes therapies with cardio- and renal-protective effects (e.g., GLP-1, SGLT-2 inhibitors). We must invest in these therapies."
- Gretchen Youssef (MedStar Health, Washington, D.C.): “I am also optimistic about the push toward value-based care. With this, we will see better care and better outcomes. The current fee-for-service model is just crazy, and people don’t get what they want or what they need in this model.”
- Jennifer Trujillo (PharmD, University of Colorado, Aurora, Colorado): “There are lots of opportunities with improvement for decision support. We are not using EHR or decision support tools as well as we could right now. Translating these better so that they are user-friendly and easy to use is a must. We also need to think about how to get resources to PCPs to better manage diabetes – this is really challenging and complex.”
- Dr. John Cuddeback (American Medical Group Association, Alexandria, Virginia): “One of the big investments is screening – identifying people with diabetes at an early stage. Only about 60% of people who should be screened are being screened. Looking at the data, the patients where you are more likely to find a diagnosis of diabetes – they are actually being screened at a lower rate than the general population."
We were interested in hearing from a wider sample of people with diabetes about how they perceive therapeutic inertia and its potential solutions. Cherise Shockley of Diabetes Social Media Advocacy (@DiabetesSocMedAd) posed the following questions during a recent Twitter chat – we wanted to share some of the answers that stood out to us:
What is one thing that should be done to improve diabetes outcomes?
- “We need better research [on behavioral interventions], more encouragement, and material support for the expense of physical training.”
What is one thing getting in the way of good diabetes outcomes that should stop?
- “The inputs we received at the very beginning, of fear, guilt, worry will cause many outputs (GIGO, Garbage in garbage out) of mental stress, anxiety and soft depression.”
What do you think is really working in diabetes innovation? What isn’t working?
- “Not working—not including patients enough to figuring out tech that works for us.”
- “Working: CGM Not working: Old ideas.”
As an individual, what single change has made the biggest difference in your personal care?
- “Peer support. Period.”
- “I typically bring a written agenda with me [to healthcare provider appointments].”
- “I tried to be a good patient with perfect numbers – failing daily, never perfect. It wore me down. Now I score like baseball – Always swing, even if it’s not a homer every time.”
What change could your provider make that would help you the most?
- “Tell the truth even if the truth is “I don’t know” how to help you.”
- “Be more familiar with resources to share with patients, such as #dsma and #doc. Be open to patients bringing resources to the HCPs, too.”
What do you think could be done differently to make sure that people with diabetes benefit from advancements in the field? ADA's Campaign for Overcoming Therapeutic Inertia will have three phases: a summit bringing together diverse stakeholders, “recognizing results and expanding reach,” and accelerating diabetes care globally through the practice of ADA Standards of Care.
By Emma Ryan