If you’re consistently taking your type 2 diabetes medication but your A1C still isn’t on target (less than 7 percent for most people with diabetes), you may be dealing with a phenomenon called therapeutic inertia.e60dc2a1-f33c-4a05-9b50-8e3e8e59762997b7314f-6d8d-4a63-a70c-04686eb2e098 Therapeutic inertia is when your diabetes treatment gets stuck in a rut even though you’re not seeing the results that you and your doctor want. Learning how to recognize therapeutic inertia, as well as how to talk about it, could be the key to finally lowering your A1C and feeling your best.
What Is Therapeutic Inertia? Therapeutic Inertia Think of therapeutic inertia as a stall in your medical care. “Therapeutic inertia happens when diabetes treatment isn’t started or adjusted even though blood glucose levels remain above the goal,” says Barbara Eichorst, RD, CDCES , vice president of healthcare programs at the American Diabetes Association (ADA). “In real life that might sound like, ‘Let’s keep everything the same and recheck in a few months,’ despite an elevated A1C.” Fewer than two-thirds of people with type 2 diabetes meet their A1C target, and these numbers have worsened over the past decade, despite the availability of new medications, better tools, and updated treatment guidelines.e60dc2a1-f33c-4a05-9b50-8e3e8e59762954cc4b9f-59f6-4925-ade6-db969499b199 While there isn’t a specific A1C reading that should prompt you to make a change, the ADA advises clinicians to try something new if patients don’t get to their goal A1C within three to six months. When treatment stays stuck for too long, high blood sugar can quietly begin to damage the heart, kidneys, nerves, and eyes.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fcd0d3a3-b17c-41cd-bc4f-63366cc7a025
Type 2 Diabetes Is a Progressive Disease Disease Progression If your A1C starts to climb after years of being steady, your first instinct may be to feel like you’ve failed, but experts encourage you to resist self-judgment. “I tell patients that A1C numbers are information, not a grade,” says Eichorst. “A rise simply means the body needs more support. Diabetes treatment is meant to evolve just like prescriptions for vision or blood pressure.” Type 2 diabetes is a progressive disease, meaning that over time the pancreas naturally makes less insulin . Factors like aging, stress, and sleep also play a role, says Eichorst. “This progression reflects the underlying biology of the disease rather than patient behavior or effort,” says Bahram Mirza, MD , chief of endocrinology at Kaiser Permanente in Riverside, California. Even if you’re doing everything right, your body may simply need a different tool as the disease moves forward.
Exploring Newer Drug Classes New Diabetes Drugs Type 2 diabetes treatment has shifted significantly in recent years. In the past, doctors focused almost entirely on glucose-centric care, prioritizing lower blood sugar , says Dr. Mirza. Now there’s a paradigm shift toward protecting organ health for the long haul, he says. Newer drug classes like glucagon-like peptide-1 (GLP-1) agonists and SGLT2 inhibitors offer multiple advantages. In addition to blood sugar management, they can have these effects:e60dc2a1-f33c-4a05-9b50-8e3e8e597629ef12c76e-5c01-42eb-8767-9303c7ef1f0b Support significant weight loss Reduce heart attack risk Slow kidney disease progression Lower risk of heart failure-related hospitalizations “High-potency GLP-1 receptor agonists can achieve weight loss over 10 percent, while SGLT2 inhibitors can reduce the risk of heart failure and kidney issues by 18 to 39 percent,” says Mirza. Older drugs like insulin and sulfonylureas are still useful, but they often cause weight gain or low blood sugar ( hypoglycemia ), and they don’t offer the same protection for the heart and kidneys. These newer options have also helped shift the way that diabetes experts think about prescribing medications. In the past, doctors would generally start with metformin and wait until A1C climbed before adding stronger treatments. But because these newer drugs are so protective, experts now suggest using them much earlier, sometimes even as a first-line add-on therapy, says Mirza.
Refocus on Lifestyle Changes Lifestyle Changes If you’re trying to eat well and move more but your A1C isn’t budging, it might be time to reframe how you think about healthy lifestyle habits . “Lifestyle modification is a medical intervention, not a test of willpower,” says Mirza. “Real change comes from sustainable habits, not short-term dieting or inconsistent exercising.” Consider building a diabetes support team , including these experts: A diabetes educator to help you understand your numbers A registered dietitian to build meal plans you enjoy eating Mental health support to handle the diabetes burnout that many people experience An exercise specialist to design a routine focused on resistance training Setting clear, simple goals around meals, movement, sleep, and stress can add up to meaningful progress over time, says Mirza.
The Risks of Therapeutic Inertia Therapeutic Inertia Risks Understanding that diabetes is a progressive disease helps explain why staying in therapeutic inertia is so risky. When blood sugar stays high for too long, it does more than just show up on a lab report. According to Mirza, prolonged high blood sugar increases the risk of serious complications, including damage to the small blood vessels in your eyes ( retinopathy ), kidneys ( nephropathy ), and nerves ( neuropathy ), as well as more serious cardiovascular events. And sustained high blood sugar accelerates insulin resistance, making it harder for your body to produce its own insulin, says Mirza. “This makes future glycemic control more difficult and narrows the window for effective intervention,” he says.
Advocate for Yourself Self-Advocacy The ADA reports that many doctors are surprised to learn that therapeutic inertia affects their own patients, which is why it may ultimately fall on you to speak up.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298f9e5e8c-f3d8-42b3-8aca-8c53b0f17a0c If your A1C has been high for three months or more, schedule an appointment with your physician to review your numbers and lifestyle habits and to discuss how your disease is progressing and impacting your quality of life:e60dc2a1-f33c-4a05-9b50-8e3e8e5976298f9e5e8c-f3d8-42b3-8aca-8c53b0f17a0c Give your doctor a real-time look at your health . Bring your glucose logs (either via a phone app or on paper), a list of all your current medications, and your monitoring devices. Address diabetes burnout . If you’re feeling overwhelmed or depressed, or if you are struggling with the cost of medication or choosing healthy foods, tell your doctor. They can offer mental health support and social resources to help. Build a custom care plan . Ask your doctor for a personal A1C target that takes your daily lifestyle and concerns into account. Then ask to review and update the plan during regular visits. Push for timely adjustments . If your A1C isn’t hitting your goal, or if your daily monitor shows high numbers, ask to adjust your therapy now rather than waiting. Then schedule a follow-up appointment to review your progress.
The Takeaway Therapeutic inertia occurs when diabetes treatment isn’t adjusted or advanced by a healthcare provider, even though blood sugar levels remain consistently above the target goal (typically an A1C of less than 7 percent). Type 2 diabetes is a progressive disease in which the body naturally becomes more insulin deficient over time; your A1C might rise over time even if you try to do everything right. Diabetes experts are recommending the earlier use of newer drugs such as GLP-1 agonists and SGLT2 inhibitors, which also protect the heart and kidneys while supporting weight loss. Overcoming inertia will require collaboration with your medical team. If you feel like your treatment is stuck in a rut, speak up and advocate for yourself.
Resources We Trust Mayo Clinic: Diabetes Care: 10 Ways to Avoid Complications American Diabetes Association: Getting to Goal: Overcoming Therapeutic Inertia in Diabetes Care Centers for Disease Control and Prevention: Put the Brakes on Diabetes Complications National Institute of Diabetes and Digestive and Kidney Diseases: Managing Diabetes JAMA Network Open: Overcoming Therapeutic Inertia in Type 2 Diabetes Care
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