Episode 14 - Clinical Inertia

Clinical Inertia and Type 2 Diabetes: Why Care Gets Stuck and How to Unstick It

In this Diabetes Podcast episode, Richie and Amber break down Clinical Inertia in type 2 diabetes—why care stalls, why A1C goals get missed, and simple steps you can start today to protect your health and aim for remission.

Keywords: Clinical Inertia, type 2 diabetes, A1C, remission, insulin resistance, beta cells, primary care, diabetes education, lifestyle change

Episode summary

You leave the doctor’s office scared. You hear “eat better, move more,” and “see you in three months.” No plan. No help. Then your A1C is higher, and you get another med. You feel stuck.

In this episode, we name the problem: Clinical Inertia. It’s when treatment does not start or does not get stronger when the A1C says it should. It’s common. It is not your fault. It is not because doctors do not care. It is the system, short visits, too many problems to cover, and not enough time for real support.

We explain why this happens, what it costs, and what actually works. We talk about the best window for remission. We give simple actions you can start today. You can take back control. You can change your story.

What we cover

• What Clinical Inertia is, in plain words
• Why short visits (about 16 minutes) lead to missed care steps
• Why so many people leave visits without a clear plan
• How delays hurt A1C goals and long-term health
• Why “more meds” without lifestyle change is not enough
• The best time window for type 2 diabetes remission
• Simple daily steps that help right now
• How to own your health outside the clinic

Timestamps

• 00:00 — The scary first visit, and why people feel lost
• 00:02 — How most people find out they have type 2 (a quick call, then Google chaos)
• 00:04 — Short visits, many problems, and “triage” in primary care
• 00:05 — Clinical Inertia defined
• 00:09 — Where lifestyle help breaks down; insurance and “info dump” classes
• 00:14 — Classes lower A1C a bit, but overload is real
• 00:16 — 1 in 3 misunderstand the plan; 60% leave without clear “what to eat/do”
• 00:18 — Clinical Inertia drives about 80% of missed A1C goals
• 00:20 — Med stacking vs fixing insulin resistance; why lifestyle is powerful
• 00:23 — Why higher A1C = higher risk (simple stats you should know)
• 00:25 — How fast meds pile up for many people
• 00:26 — The best window for remission is early (1–3 years post-diagnosis)
• 00:27 — Your beta cells need urgent help; delays matter
• 00:29 — When doctors say “I can’t help more,” and why that happens
• 00:30 — The big system problem vs what you can do now
• 00:31 — Own your health like your money: day-to-day is on you
• 00:35 — Hope: remission is real; behavior change works
• 00:35 — Simple steps to start today
• 00:38 — When A1C is “flat, flat… then jumps,” that’s inertia
• 00:38 — Free resources and fast-track help at EmpoweredDiabetes.com
• 00:39 — Closing: You deserve a plan, a partner, and real change

Clinical Inertia: what it is and why it happens

• Simple meaning: care does not start or does not ramp up when your A1C shows it should.
• Why it happens:
  • Primary care doctors care for 1,800–2,000 patients.
  • Visits are short (about 16 minutes).
  • About six problems per visit. Diabetes competes with other urgent issues.
  • Real life happens: floods, stress, pain. Doctors are human and try to help with what’s most urgent.
  • Group classes are often “info dumps.” People leave overwhelmed.
  • Insurance pays for very limited visits. Not much for ongoing support.

What Clinical Inertia costs

• About 80% of people who miss their A1C goals do so because care was delayed, diluted, or dismissed.
• Many leave visits confused:
  • 1 in 3 misunderstand the plan after a standard visit.
  • Over 60% leave without clear steps on what to eat or do.
• Risks rise as A1C rises (UKPDS 1% rule):
  • For each 1% A1C above 7:
    • 21% higher risk of death due to diabetes
    • 14% higher risk of heart attack
    • 37% higher risk of small blood vessel damage (eyes, kidneys, nerves)
  • An A1C of 9 can double the risk of kidney failure, blindness, and stroke over time.

Why “more meds” alone is not the fix

• What often happens: metformin → add-ons (like DPP-4, SGLT2) → more meds → insulin.
• These can help, but many do not fix insulin resistance, the core problem.
• Without lifestyle change, meds pile up while the root issue stays.
• Data shows:
  • Within 5 years, about 50% are on multiple meds.
  • About one-third are on three or more.

The best window for remission