Therapeutic inertia: a retrospective examination of inpatient management for type 2 diabetes mellitus at a South African regional hospital during a singular hospitalisation


  • KA White Harry Gwala Regional Hospital
  • S Pillay University of KwaZulu-Natal


glycaemic management, insulin initiation, insulin intensification, retrospective analysis, therapeutic inertia (TI), type 2 diabetes mellitus (T2DM)


Background: Therapeutic inertia (TI), the clinicians’ hesitancy to either instigate or escalate therapeutic measures despite clinical evidence, has been identified as a significant hindrance in achieving ideal glycaemic management in type 2 diabetes mellitus (T2DM) patients globally, including in South Africa.

Objective: This research purposed to quantify the prevalence of TI in relation to long-term insulin initiation and intensification within inpatients during a single admission at a regional-level public hospital in South Africa.

Methods: A retrospective analysis of 300 consecutive inpatient admissions to Harry Gwala Regional Hospital from 28 May 2022 was conducted.

Results: From the 300 charts identified, 46 were deemed ineligible, leaving 254 for comprehensive assessment. TI was detected in 107 instances (42%), with 73 (68%) of these incidences pertinent to long-term insulin commencement or dosage adjustment during that admission. A younger demographic was the sole discernible protective factor against TI (p = 0.035).

Conclusions: The prevalence of TI among T2DM inpatients during a single admission within a KwaZulu Natal public institution is significant, mirroring figures from global studies. Most of this inertia is affiliated with insulin-based strategies, resonating with global patterns. Advanced investigations are imperative to pinpoint specific impediments and strategize countermeasures against TI in such an environment as well as in general.

Author Biographies

KA White, Harry Gwala Regional Hospital

Harry Gwala Regional Hospital, South Africa

S Pillay, University of KwaZulu-Natal

Department of Internal Medicine, King Edward VIII Hospital and Department of Internal Medicine, University of KwaZulu-Natal, South Africa






Original Research