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Earlier this year we published the first evaluation, to our knowledge, of adherence to the national target criteria for good disease management in diabetes in tertiary diabetes care. The study was based on the Swiss Diabetes Registry (SwissDiab), an ongoing national multicentre prospective observational study coordinated from Kantonsspital St. Gallen.

The study findings raised the following two questions related to the quality of diabetes care:

1. Why did a significantly larger proportion of T1D and T2D participants with longer diabetes duration (>5 years) fail to reach an HbA1c <7% compared to participants with short diabetes duration (≤5 years)? Is it primarily due to disease progression?

2. Why did a significantly larger proportion of T2D participants with short diabetes duration (≤5 years) fail to reach the treatment targets for plasma LDL-cholesterol compared to participants with longer diabetes duration (>5 years)?

With the current project we will use longitudinal SwissDiab data to investigate if therapeutic inertia, defined as the failure to initiate or intensify therapeutic treatment when a patient is not reaching the treatment target, is part of the answer to the two questions above. This is important as sub-optimal glycaemic control and LDL-cholesterol levels increase the risk of diabetes-related complications and cardiovascular disease. If the increased risk is partially due to therapeutic inertia, it can be intervened upon by raising awareness and by revising daily clinical practise routines. In the end, personal suffering and strain on health care resources could be spared.

All SwissDiab centres with data available for analysis will be included. All analyses will be done in T1D and T2D separately.