Assessing Clinical Inertia on Implementing Clinical Guideline Recommendations in Patients with Type 2 Diabetes: A Clinician Survey Study

Judith J Stephenson,1 Nancy Witkowski,2 Joseph L Smith,1 Anny C Wong,2 Lindsay GS Bengtson,2 Vincent J Willey1 1Carelon Research, Wilmington, DE, USA; 2Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USACorrespondence: Judith J Stephenson, Carelon Research, 123 Justison Street, Suite 200, Wilmington, DE, 19801, USA, Tel +1 302-547-5770, Email [email protected]: To evaluate how clinicians’ attitudes, knowledge and treatment behavior align with American Diabetes Association (ADA) standards of care (SOC) clinical practice guidelines (CPGs).Research Design and Methods: A cross-sectional internet survey was conducted among clinicians caring for patients with type 2 diabetes who were identified from administrative claims in a large United States administrative claims database. Eligible clinicians consisted of primary care physicians, endocrinologists, physician assistants, and nurse practitioners. The survey assessed attitudes toward, knowledge of, and use of ADA CPGs related to cardiometabolic SOC. Clinicians’ “real-world” use of CPGs was assessed by calculating the attainment of six therapeutic management (TM) measures using administrative claims data. TM measure attainment was defined as the proportion of eligible patients receiving guideline-concordant care and was calculated only for measures where clinicians had ≥ 5 eligible patients. Clinicians’ survey data were linked with their TM measure attainment data for analytic purposes.Results: A total of 402 clinicians completed the survey and 314 clinicians had at least one TM measure attainment. Despite generally positive attitudes and adequate guideline knowledge, TM attainment was below 50% on four of the six TM measures and correlations between attitudes, knowledge, and TM attainment were low. Concordance/discordance analysis showed the “guideline inertia” group consisting of clinicians with high knowledge but low TM measure attainment to be the most frequently occurring group. Adoption of GLP-1 receptor agonists and SGLT2 inhibitors remained low among clinicians treating patients with comorbid ASCVD, heart failure, or chronic kidney disease.Conclusion: Clinicians demonstrated adequate knowledge of ADA SOC but showed persistent clinical inertia in translating this knowledge into cardiometabolic risk management. These findings highlight that knowledge alone is insufficient for achieving guideline-concordant prescribing behavior. Multi-level strategies incorporating clinician education, system-level support, and patient engagement may be required to improve adoption of evidence-based therapies.Keywords: guideline adherence, cardiometabolic risk, type 2 diabetes, GLP-1 receptor agonists, SGLT2 inhibitors, clinical inertia