Clinical inertia among patients with type 2 diabetes mellitus in upper-middle-income countries: A systematic review and meta-analysis

Background: Despite its critical importance, there has been no comprehensive quantitative synthesis focused specifically on clinical inertia in upper-middle-income countries. Without pooled prevalence estimates, identification of common predictors, and contextual insights into consequences, policymakers and clinicians in these settings are limited in their capacity to design targeted interventions. Objective: This study aimed to estimate the pooled estimate of clinical inertia among adults with type 2 diabetes mellitus in upper-middle-income countries. Design: This study was conducted as a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources and methods: A comprehensive search was conducted using electronic databases such as PubMed, Science Direct, African Journals Online, and Google Scholar. All retrieved records were imported into EndNote reference manager, and duplicates were removed. The methodological quality of included observational cross-sectional studies was assessed using the Modified Newcastle-Ottawa Scale adapted for cross-sectional and cohort studies. Data were extracted from all studies that met the inclusion criteria using the Joanna Briggs Institute standardized data extraction form in Microsoft Excel. Quantitative data were analyzed using STATA software version 17. Heterogeneity between studies was assessed using the Cochran’s Q test and quantified with the Higgins ( I 2 ) statistic. Results: Ultimately, 13 studies met the eligibility criteria and were included in the final review. In this study, the pooled effect size using the random-effects model was estimated to be 45.56% (95% CI: 32.87–58.25). The pooled prevalence should be interpreted as a summary measure reflecting the overall body of evidence, as substantial between-study heterogeneity was observed ( I 2 = 99.8%). Diabetes complications and comorbidities were significantly associated with clinical inertia. Conclusion: The findings highlight considerable variability in the reported prevalence of clinical inertia across upper-middle-income countries, suggesting important contextual and methodological differences between studies. This meta-analysis demonstrates that diabetes complications and comorbidities are significantly associated with clinical inertia. Overall, these findings highlight that clinical inertia remains a pervasive barrier to optimal chronic disease management. Health systems should prioritize patients with diabetes complications and multiple comorbidities for timely monitoring and treatment adjustments. Trial registration: CRD420251231712.