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June 1, 2026Diabetes Metabolic Syndrome and Obesity0 citationsOpen Access

Therapeutic Inertia in Type 2 Diabetes in Indian Primary Care: A Scoping Review

LSLokesh Shanmugam SGSiva Ranganathan Green ASA Sathya

Key Points

This review aims to explore the barriers to achieving optimal glycaemic control in type 2 diabetes mellitus in Indian primary health care settings.
Conducted a scoping review following PRISMA-ScR guidelines.
Performed systematic search of electronic databases and relevant policy documents from 2010 to 2025.
Included studies addressing therapeutic inertia in type 2 diabetes at global and Indian levels for thematic analysis.
Global evidence on therapeutic inertia indicates delays in treatment intensification and challenges in clinical decision-making.
Indian evidence is limited, primarily from urban and tertiary care, showing barriers like patient fear and clinical conservatism.
Lack of longitudinal and interventional studies specifically focused on primary health care in India.

Abstract

Lokesh Shanmugam,1 Siva Ranganathan Green,2 A Sathya,3 Joshua Chadwick1 1Indian Council of Medical ResearchâNational Institute of Epidemiology, Chennai, Tamil Nadu, India; 2Internal Medicine Department, Mahatma Gandhi Medical College 3Internal Medicine Department, Government Stanley Medical College, Chennai, Tamil Nadu, IndiaCorrespondence: Lokesh Shanmugam, Email lokeshsdr@gmail.comBackground: Therapeutic inertia (TI) is a significant barrier to achieving optimal glycaemic control in type 2 diabetes mellitus (T2DM), particularly in primary health care (PHC) settings in India. Despite growing global attention, evidence from Indian PHC remains limited and fragmented.Methods: A scoping review was conducted following PRISMA-ScR guidelines. A systematic search of electronic databases and relevant policy documents was performed to identify studies published between 2010 and 2025. Studies addressing therapeutic inertia in T2DM at global and Indian levels were included and thematically analysed.Results: The findings indicate that global evidence on therapeutic inertia is extensive, highlighting delays in treatment intensification, clinical decision-making challenges, and health system inefficiencies. In contrast, Indian evidence is relatively limited and predominantly derived from urban and tertiary care settings. Across studies, therapeutic inertia was influenced by multiple factors, including patient-related barriers (eg, fear and lack of awareness), provider-related factors (eg, clinical conservatism), and system-level constraints (eg, resource limitations). Notably, there is a lack of longitudinal and interventional studies focusing on PHC in India.Conclusion: Therapeutic inertia remains a multifactorial challenge in T2DM management, particularly in Indian PHC settings where evidence gaps persist. Strengthening primary care systems, promoting implementation research, and developing context-specific interventions are essential to address this issue and improve diabetes outcomes.Keywords: therapeutic inertia, type 2 diabetes mellitus, primary health care, glycemic control, NPCDCS, PRISMA-ScR

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