Background: Type 2 diabetes mellitus (T2DM) cases are increasing globally and in Indonesia, leading to significant economic impacts due to the high cost of treating complications. Optimal glycemic control, measured by HbA1c levels, is essential to reduce the risk of microvascular and macrovascular complications. However, many patients fail to achieve targets, often due to clinical inertia, defined as the discrepancy between clinical guidelines and actual clinical practice. Objectives: This study aims to determine the proportion of patients achieving optimal glycemic control in primary healthcare facilities in Malang, Indonesia, and to identify the factors of clinical inertia affecting HbA1c achievement.

Methods: This cross-sectional observational study used secondary medical record data from 2,256 PROLANIS patients in Malang City from January to December 2020, alongside primary data from questionnaires given to doctors (n=123), healthcare system representatives (n=99), and patients (n=358). Data were analysed using descriptive statistics, bivariate analysis (chi-square and T-tests), and binomial logistic regression.

Results: Only 32% of the total population achieved the optimal HbA1c target of <7%.Factors significantly influencing the failure to achieve control included age, gender, lipid profile (total cholesterol, HDL, LDL, TG), and microalbuminuria. Among drug regimens, Metformin had the highest percentage of success, while Sulfonylurea +Metformin had the highest failure rate. Regarding clinical inertia, good clinical practice by doctors was significantly supported by the utilisation of guidelines (96% probability), moderate workloads (99% probability), and effective patient education (98%probability). In the healthcare system, adequate laboratory examination was the dominant factor (98% probability) for success. While patient knowledge was generally moderate, it did not significantly correlate with treatment adherence.

Conclusion: Glycemic control among T2DM patients in Malang remains low (32%), consistent with previous findings in Indonesia. While primary care doctors generally follow ideal clinical practices, the lack of a standardised guideline across all PROLANIS service providers remains a systemic challenge that contributes to clinical inertia.

Rinadhi Reza Bramantya is affiliated with the Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Faculty of Medicine, Brawijaya University, Malang, Indonesia. His clinical and research work focuses on diabetes care, particularly glycemic control and management of type 2 diabetes mellitus in primary healthcare settings.