Association between a structured training programme and self-reported clinical inertia in type 2 diabetes management in primary care

This non-randomised, post-intervention–only controlled cross-sectional study examined the association between participation in the Turkish Diabetes Foundation’s face-to-face training and patient counselling programme (Diabetes 01) and self-reported clinical decision-making among primary care physicians managing type 2 diabetes mellitus (T2DM). The programme was implemented in Adana, southern Turkey, between November 2021 and June 2022. After programme completion, a standardised questionnaire evaluating treatment initiation, treatment modification, and referral practices was administered to 118 trained family physicians (Group A) and 516 untrained physicians (Group B). Compared with untrained physicians, trained physicians reported a lower likelihood of direct referral to higher-level care (3·4% vs. 13·0%; odds ratio [OR] 0·24, 95% CI 0·08–0·66) and reported fewer referrals at relatively low HbA1c thresholds (13·6% vs. 32·0%; OR 0·33, 95% CI 0·19–0·58). Conversely, the likelihood of referral was greater among trained physicians in the context of very high HbA1c levels (e.g., > 10·0%). Trained physicians were also more likely to report initiating pharmacological treatment at lower HbA1c thresholds, including HbA1c values just above 6·5% (OR 1·55, 95% CI 1·03–2·32). No significant between-group differences were observed in treatment intensification thresholds or preferred target HbA1c levels. Overall, participation in the Diabetes 01 programme was associated with a modest shift toward earlier treatment initiation and reduced self-reported referral at earlier disease stages. However, causal inference is limited, and effects on actual clinical practice and patient outcomes cannot be determined.