Association between therapeutic inertia and future hypoglycemia among patients with type 2 diabetes

Therapeutic inertia (TI), the failure to adjust therapy when HbA1c remains above- target, is a barrier to optimal glycemic control in type 2 diabetes (T2D). This study examined the association between TI and subsequent-year hypoglycemia visit, and whether continuous glucose monitoring (CGM) modifies this relationship. We analyzed electronic health records (2017–2023) from two Midwest US healthcare systems, including adults with T2D, at least one above-target HbA1c (>7% for ages 18–64; >8% for ages ≥65), and glucose-lowering prescriptions. TI was calculated annually as the percentage of above-target HbA1c results without prescription changes within 30 days. We fitted logistic regression models to examine whether high TI (>50%) was associated with subsequent-year hypoglycemia visits. An interaction term tested whether this association differed between those who used vs. did not use CGM. Among 65,983 participants (mean age 56, 51% male, 75% White), mean HbA1c at last follow-up was 8.1% (ages 18–64) and 8.0% (ages ≥ 65). High TI was associated with 31% increased odds of hypoglycemia visit (OR=1.74; 95% CI: 1.61–1.88; p