Diabetes, Therapeutic Inertia, and Patients’ Medication Experience

Abstract

Factors contributing to therapeutic inertia related to patients’ medication experiences include concerns about side effects and out-of-pocket costs, stigmatization for having diabetes, confusion about frequent changes in evidence-based guidelines, low health literacy, and social determinants of health. A variety of solutions to this multifactorial problem may be necessary, including integrating pharmacists into interprofessional care teams, using medication refill synchronization programs, maximizing time with patients to discuss fears and concerns, being cognizant of language used to discuss diabetes-related topics, and avoiding stigmatizing patients. Managing diabetes successfully is a team effort, and the full commitment of all team members (including patients) is required to achieve desired outcomes through an individualized approach.

Willingness to start insulin therapy among insulin-naïve persons with type 2 diabetes mellitus at Gulu Regional Referral Hospital, Gulu City, Uganda

“… 10 Therefore, the basal insulin dose in conjunction with oral therapy is widely used to initiate insulin therapy, though, even when fasting hyperglycemia is under control, it is necessary to control post-prandial hyperglycemia to achieve target HbA1c levels. 18 According to a study by Bzowyckyj and Begert, 19 the factors that led to therapeutic inertia related to patients’ medication experiences such as the concerns about medication side effects and treatment costs, society-attached stigma, confusion about frequent changes in evidence-based guidelines, low health literacy, and social determinants of health. 12 …”

Overcoming Therapeutic Inertia in the Age of Advanced Diabetes Medication Therapy and Technology

“…Failure to act, either through proper screening according to guidelines or through a change in dose or the addition of an agent, when A1C is above goal has severe consequences for PWD (Table 1) and misunderstanding of treatment dosing regimens. 1,6 Fear of needles and injection-related anxiety also play a role. 1,3 PWD report that fear of self-monitoring of blood glucose, pain from injections, weight gain, anxiety over changing doses of insulin, and psychological resistance to insulin were barriers to insulin therapy.…”

“…1,3 Additionally, not being able to follow dietary A multidisciplinary team approach may not only reduce the provider's burden but will also overcome therapeutic inertia related to HC systems. 3,6 Studies showed that adding HCP…”

“…trained in diabetes care and education can assist with management strategies 1. A multidisciplinary team-based approach can increase the confidence and skills of the team 6. A protocol that includes sharing regular updates with members of the multidisciplinary team can be integrated to the service delivery plan and assist in ensuring proper care.…”