Can't Lower Your A1C? How to Fight Type 2 Diabetes Therapeutic Inertia

Learning how to recognize therapeutic inertia, as well as how to talk about it, could be the key to finally lowering your A1C and feeling your best.

Think of therapeutic inertia as a stall in your medical care.

“Therapeutic inertia happens when diabetes treatment isn’t started or adjusted even though blood glucose levels remain above the goal,” says Barbara Eichorst, RD, CDCES, vice president of healthcare programs at the American Diabetes Association (ADA). “In real life that might sound like, ‘Let’s keep everything the same and recheck in a few months,’ despite an elevated A1C.”

If your A1C starts to climb after years of being steady, your first instinct may be to feel like you’ve failed, but experts encourage you to resist self-judgment.

“I tell patients that A1C numbers are information, not a grade,” says Eichorst. “A rise simply means the body needs more support. Diabetes treatment is meant to evolve just like prescriptions for vision or blood pressure.”

Type 2 diabetes is a progressive disease, meaning that over time the pancreas naturally makes less insulin. Factors like aging, stress, and sleep also play a role, says Eichorst.

“This progression reflects the underlying biology of the disease rather than patient behavior or effort,” says Bahram Mirza, MD, chief of endocrinology at Kaiser Permanente in Riverside, California. Even if you’re doing everything right, your body may simply need a different tool as the disease moves forward.

Type 2 diabetes treatment has shifted significantly in recent years. In the past, doctors focused almost entirely on glucose-centric care, prioritizing lower blood sugar, says Dr. Mirza. Now there’s a paradigm shift toward protecting organ health for the long haul, he says.

• Support significant weight loss
• Reduce heart attack risk
• Slow kidney disease progression
• Lower risk of heart failure-related hospitalizations

“High-potency GLP-1 receptor agonists can achieve weight loss over 10 percent, while SGLT2 inhibitors can reduce the risk of heart failure and kidney issues by 18 to 39 percent,” says Mirza.

Older drugs like insulin and sulfonylureas are still useful, but they often cause weight gain or low blood sugar (hypoglycemia), and they don't offer the same protection for the heart and kidneys.

These newer options have also helped shift the way that diabetes experts think about prescribing medications. In the past, doctors would generally start with metformin and wait until A1C climbed before adding stronger treatments. But because these newer drugs are so protective, experts now suggest using them much earlier, sometimes even as a first-line add-on therapy, says Mirza.

If you're trying to eat well and move more but your A1C isn’t budging, it might be time to reframe how you think about healthy lifestyle habits.

“Lifestyle modification is a medical intervention, not a test of willpower,” says Mirza. “Real change comes from sustainable habits, not short-term dieting or inconsistent exercising.”

Consider building a diabetes support team, including these experts:

• A diabetes educator to help you understand your numbers
• A registered dietitian to build meal plans you enjoy eating
• Mental health support to handle the diabetes burnout that many people experience
• An exercise specialist to design a routine focused on resistance training

Setting clear, simple goals around meals, movement, sleep, and stress can add up to meaningful progress over time, says Mirza.

Understanding that diabetes is a progressive disease helps explain why staying in therapeutic inertia is so risky. When blood sugar stays high for too long, it does more than just show up on a lab report.

According to Mirza, prolonged high blood sugar increases the risk of serious complications, including damage to the small blood vessels in your eyes (retinopathy), kidneys (nephropathy), and nerves (neuropathy), as well as more serious cardiovascular events.

And sustained high blood sugar accelerates insulin resistance, making it harder for your body to produce its own insulin, says Mirza. “This makes future glycemic control more difficult and narrows the window for effective intervention,” he says.

• Give your doctor a real-time look at your health. Bring your glucose logs (either via a phone app or on paper), a list of all your current medications, and your monitoring devices.
• Address diabetes burnout. If you’re feeling overwhelmed or depressed, or if you are struggling with the cost of medication or choosing healthy foods, tell your doctor. They can offer mental health support and social resources to help.
• Build a custom care plan. Ask your doctor for a personal A1C target that takes your daily lifestyle and concerns into account. Then ask to review and update the plan during regular visits.
• Push for timely adjustments. If your A1C isn't hitting your goal, or if your daily monitor shows high numbers, ask to adjust your therapy now rather than waiting. Then schedule a follow-up appointment to review your progress.

• Therapeutic inertia occurs when diabetes treatment isn’t adjusted or advanced by a healthcare provider, even though blood sugar levels remain consistently above the target goal (typically an A1C of less than 7 percent).
• Type 2 diabetes is a progressive disease in which the body naturally becomes more insulin deficient over time; your A1C might rise over time even if you try to do everything right.
• Diabetes experts are recommending the earlier use of newer drugs such as GLP-1 agonists and SGLT2 inhibitors, which also protect the heart and kidneys while supporting weight loss.
• Overcoming inertia will require collaboration with your medical team. If you feel like your treatment is stuck in a rut, speak up and advocate for yourself.