TABLE 1.

Diabetes Therapy Intensification: Influencing Factors and Proposed Solutions From Providers and Patients With Type 2 Diabetes

Factors Influencing Diabetes Therapy Intensification PracticesProposed Solutions
PCPs’ and pharmacists’ perspectives:
  • Psychological insulin resistance (e.g., needle phobia)

  • Limited self-knowledge about insulin therapy, devices, and techniques

  • Lack of prescription specificity (e.g., needle size omitted)

  • Communication or lack thereof about the progressive nature of diabetes

  • Inadequate patient education because of time constraints and providers’ knowledge gaps

  • Shortage of in-office staff with diabetes-specific knowledge

  • Need for more CME programs on diabetes intensification therapies and tools and strategies for introducing them to patients

  • Improve providers’ and pharmacists’ knowledge (e.g., through CME courses) on:

    • ◦ New therapies and tools

    • ◦ Strategies for engaging patients and improving adherence

  • Implement office-based interventions and education addressing:

    • ◦ Patient-centered approaches

    • ◦ Application of techniques (e.g., motivational interviewing) to encourage patients to initiate and adhere to recommendations

    • ◦ Injection demonstrations

  • Integrate diabetes specialists (e.g., DEs and endocrinologists) into patient care

  • Develop guidelines or strategies for ensuring that patients are prescribed insurance-approved devices and medications

  • Provide information on costs to facilitate informed decision-making

  • Provide on-site demonstrations of injectable medications

  • Link to resources (e.g., medication assistance programs)

Patients’ perspectives:
  • Sense of personal failure

  • Needle phobia and concerns with pain

  • Concerns with insulin logistics (e.g., safety, side effects, and complications)

  • Continuity of care or lack thereof

  • Cost

  • Education and demonstration of tools influence willingness to initiate and continue adherence to intensified therapy