{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T21:03:22Z","timestamp":1791407002955,"version":"4.3.3"},"reference-count":37,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"unspecified","delay-in-days":52,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Collaborative to Advance Clinical Health Equity","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K01HL140146"],"award-info":[{"award-number":["K01HL140146"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["UL1TR002553"],"award-info":[{"award-number":["UL1TR002553"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Veterans Affairs Quality Enhancement Research Initiative","award":["VA QUE 20-012"],"award-info":[{"award-number":["VA QUE 20-012"]}]},{"name":"Duke University Health System","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"publisher","award":["1R01NR019594-01"],"award-info":[{"award-number":["1R01NR019594-01"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017618","name":"Division of Diabetes, Endocrinology, and Metabolic Diseases","doi-asserted-by":"publisher","award":["T32DK007012"],"award-info":[{"award-number":["T32DK007012"]}],"id":[{"id":"10.13039\/100017618","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2026,4,4]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Therapeutic inertia (failure to initiate or intensify therapy when therapeutic goals are unmet) contributes to poor glycemic control and diabetes-related complications. We assessed the extent of therapeutic inertia, defined as a lack of new prescription orders for sodium-glucose cotransporter-2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1RA), among patients with type 2 diabetes and above-target hemoglobin A1c who had clinical indications for use, were not currently using these medications, and had no contraindications. We also examined whether prescribing patterns differed by race and ethnicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research design and methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort analysis of 2018\u20132022 electronic health record data. Log-link Poisson generalized estimating equation models estimated relative risks (RR) and assessed predictors of therapeutic inertia and trends over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 10\u2009345 eligible patients (30\u2009740 encounters), 56% were White, 37% Black, 3% Hispanic, 2% Asian, and 2% other races and ethnicities. The rate of new prescribing increased over time but remained low (SGLT2i: 0.9%\u20134.3%; GLP-1RA: 1.2%\u20135.2%). After adjusting for sociodemographic, clinical, and service factors, Black patients were less likely than White patients to receive new SGLT2i (RR 0.59, 95% CI 0.42 to 0.82) and GLP-1RA (RR 0.62, 95% CI 0.49 to 0.79) prescriptions; Hispanic patients were less likely to receive new GLP-1RA prescriptions (RR 0.48, 95% CI 0.25 to 0.92).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite compelling indications, initiation of SGLT2i and GLP-1RA remained low overall and was significantly lower among Black and Hispanic patients, underscoring therapeutic inertia as a modifiable barrier to optimal diabetes care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjdrc-2025-005546","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T16:25:52Z","timestamp":1776875152000},"page":"e005546","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Low uptake and disparities in therapeutic inertia of cardiorenal protective diabetes medications for patients with type 2 diabetes and above-target hemoglobin A1c"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8091-1941","authenticated-orcid":false,"given":"Jashalynn","family":"German","sequence":"first","affiliation":[{"name":"Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei Angel","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Brucker","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khayla","family":"Daniel","sequence":"additional","affiliation":[{"name":"Duke Health Integrated Practice, Duke Health, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Halpern","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA"},{"name":"Duke Primary Care, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nrupen","family":"Bhavsar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenia","family":"McPeek Hinz","sequence":"additional","affiliation":[{"name":"Duke Health Technology Solutions, Duke University Health System Inc, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Shannon","sequence":"additional","affiliation":[{"name":"Duke University Health System, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Pignone","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J","family":"Crowley","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan C","family":"Batch","sequence":"additional","affiliation":[{"name":"Medicine, Division of Endocrinology, Duke University, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin A","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan Elizabeth","family":"Spratt","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"2026042206250558000_14.2.e005546.1","unstructured":"Control CfD, Prevention . National diabetes statistics report. 2023."},{"key":"2026042206250558000_14.2.e005546.2","doi-asserted-by":"publisher","DOI":"10.1089\/pop.2015.0181"},{"key":"2026042206250558000_14.2.e005546.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-018-4711-2"},{"key":"2026042206250558000_14.2.e005546.4","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.ecl.2021.05.006","article-title":"Ethnic Disparities in Diabetes","volume":"50","author":"Mikhail","year":"2021","journal-title":"Endocrinol Metab Clin North Am"},{"key":"2026042206250558000_14.2.e005546.5","doi-asserted-by":"crossref","DOI":"10.1002\/dmrr.3097","article-title":"Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States","volume":"35","author":"Aguayo-Mazzucato","year":"2019","journal-title":"Diabetes Metab Res Rev"},{"key":"2026042206250558000_14.2.e005546.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1911303"},{"key":"2026042206250558000_14.2.e005546.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1811744"},{"key":"2026042206250558000_14.2.e005546.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603827"},{"key":"2026042206250558000_14.2.e005546.9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1504720"},{"key":"2026042206250558000_14.2.e005546.10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1611925"},{"key":"2026042206250558000_14.2.e005546.11","doi-asserted-by":"crossref","first-page":"435","DOI":"10.18553\/jmcp.2021.27.4.435","article-title":"Health care utilization and costs associated with switching from DPP-4i to GLP-1RA or SGLT2i: an observational cohort study","volume":"27","author":"Newman","year":"2021","journal-title":"JMCP"},{"key":"2026042206250558000_14.2.e005546.12","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-021-05529-w"},{"key":"2026042206250558000_14.2.e005546.13","doi-asserted-by":"publisher","DOI":"10.2337\/cd17-0119"},{"key":"2026042206250558000_14.2.e005546.14","doi-asserted-by":"publisher","DOI":"10.2337\/dc22-S009"},{"key":"2026042206250558000_14.2.e005546.15","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20220039"},{"key":"2026042206250558000_14.2.e005546.16","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s12933-018-0699-7","article-title":"Antidiabetic treatment patterns and specialty care utilization among patients with type 2 diabetes and cardiovascular disease","volume":"17","author":"Pantalone","year":"2018","journal-title":"Cardiovasc Diabetol"},{"key":"2026042206250558000_14.2.e005546.17","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.041730"},{"key":"2026042206250558000_14.2.e005546.18","doi-asserted-by":"crossref","DOI":"10.1002\/edm2.76","article-title":"The prevalence of cardiovascular disease and antidiabetes treatment characteristics among a large type 2 diabetes population in the United States","volume":"2","author":"Weng","year":"2019","journal-title":"Endocrinol Diabetes Metab"},{"key":"2026042206250558000_14.2.e005546.19","first-page":"469","article-title":"Contemporary Treatment Patterns and Clinical Outcomes of Comorbid Diabetes Mellitus and HFrEF","volume":"8","author":"Vaduganathan","year":"2020","journal-title":"JACC: Heart Failure"},{"key":"2026042206250558000_14.2.e005546.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2023.03.024"},{"key":"2026042206250558000_14.2.e005546.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2025-003499","article-title":"Overcoming therapeutic inertia in primary care: a multisite quality initiative to increase guideline-based prescribing for patients with diabetes","volume":"14","author":"Latreille","year":"2025","journal-title":"BMJ Open Qual"},{"key":"2026042206250558000_14.2.e005546.22","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2296-15-130","article-title":"The concept and definition of therapeutic inertia in hypertension in primary care: a qualitative systematic review","volume":"15","author":"Lebeau","year":"2014","journal-title":"BMC Fam Pract"},{"key":"2026042206250558000_14.2.e005546.23","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1007\/s12325-018-0819-5","article-title":"Addressing Clinical Inertia in Type 2 Diabetes Mellitus: A Review","volume":"35","author":"Okemah","year":"2018","journal-title":"Adv Ther"},{"key":"2026042206250558000_14.2.e005546.24","doi-asserted-by":"crossref","DOI":"10.3390\/medicina59010182","article-title":"Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review","volume":"59","author":"Almigbal","year":"2023","journal-title":"Medicina (Kaunas)"},{"key":"2026042206250558000_14.2.e005546.25","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.6139","article-title":"Association of Race\/Ethnicity, Gender, and Socioeconomic Status With Sodium-Glucose Cotransporter 2 Inhibitor Use Among Patients With Diabetes in the US","volume":"4","author":"Eberly","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026042206250558000_14.2.e005546.26","doi-asserted-by":"crossref","DOI":"10.1001\/jamahealthforum.2021.4182","article-title":"Racial, Ethnic, and Socioeconomic Inequities in Glucagon-Like Peptide-1 Receptor Agonist Use Among Patients With Diabetes in the US","volume":"2","author":"Eberly","year":"2021","journal-title":"JAMA Health Forum"},{"key":"2026042206250558000_14.2.e005546.27","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1053\/j.ajkd.2022.11.017","article-title":"Predictors, Disparities, and Facility-Level Variation: SGLT2 Inhibitor Prescription Among US Veterans With CKD","volume":"82","author":"Gregg","year":"2023","journal-title":"Am J Kidney Dis"},{"key":"2026042206250558000_14.2.e005546.28","doi-asserted-by":"publisher","DOI":"10.1001\/JAMA.2022.13885"},{"key":"2026042206250558000_14.2.e005546.29","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2019.0213"},{"key":"2026042206250558000_14.2.e005546.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2022.114759"},{"key":"2026042206250558000_14.2.e005546.31","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.47656","article-title":"Trends and Disparities in Glycemic Control and Severe Hyperglycemia Among US Adults With Diabetes Using Insulin, 1988-2020","volume":"5","author":"Venkatraman","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026042206250558000_14.2.e005546.32","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1802313"},{"key":"2026042206250558000_14.2.e005546.33","doi-asserted-by":"crossref","unstructured":"Andrade C . How to Use Percentiles to Better Understand Standardized Mean Difference (SMD) as a Measure of Effect Size. J Clin Psychiatry 2023;84. doi:10.4088\/JCP.23f15028","DOI":"10.4088\/JCP.23f15028"},{"key":"2026042206250558000_14.2.e005546.34","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.48030","article-title":"Use of Lipid-, Blood Pressure-, and Glucose-Lowering Pharmacotherapy in Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease","volume":"5","author":"Nelson","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026042206250558000_14.2.e005546.35","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajpc.2023.100477","article-title":"Call to action: Understanding the differences in the use of SGLT-2 inhibitors and GLP-1 receptor agonists","volume":"13","author":"Khedagi","year":"2023","journal-title":"Am J Prev Cardiol"},{"key":"2026042206250558000_14.2.e005546.36","doi-asserted-by":"crossref","DOI":"10.1016\/j.xkme.2022.100564","article-title":"Disparities in SGLT2 Inhibitor or Glucagon-Like Peptide 1 Receptor Agonist Initiation Among Medicare-Insured Adults With CKD in the United States","volume":"5","author":"Zhao","year":"2023","journal-title":"Kidney Med"},{"key":"2026042206250558000_14.2.e005546.37","doi-asserted-by":"crossref","DOI":"10.1001\/jamahealthforum.2021.4205","article-title":"Coverage, Formulary Restrictions, and Affordability of Sodium-Glucose Cotransporter 2 Inhibitors by US Insurance Plan Types","volume":"2","author":"Tummalapalli","year":"2021","journal-title":"JAMA Health Forum"}],"container-title":["BMJ Open Diabetes Research &amp; Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjdrc-2025-005546","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T16:25:57Z","timestamp":1776875157000},"score":1,"resource":{"primary":{"URL":"https:\/\/drc.bmj.com\/lookup\/doi\/10.1136\/bmjdrc-2025-005546"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":37,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,4,22]]},"published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1136\/bmjdrc-2025-005546"],"URL":"https:\/\/doi.org\/10.1136\/bmjdrc-2025-005546","relation":{},"ISSN":["2052-4897"],"issn-type":[{"value":"2052-4897","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]}}}