Diabetes Pro Quarterly - Spring 2021 - 5

Professional News

" Critical Conversations " Framework Aims at Overcoming Resistance
to Therapy Intensification in People with Diabetes
There is high-quality evidence that timely therapy
intensification (treating to goal) has long-term health benefits
for people with type 2 diabetes. Research has confirmed a socalled " legacy effect " associated with achieving A1C targets
early can help prevent or delay complications and improve
quality of life for years to come. Despite this evidence,
research has also shown that therapy intensification delays
when people with diabetes fail to meet goals is too often the
norm. These delays, referred to as " therapeutic inertia, " are a
significant contributor to poor outcomes in diabetes globally.
To help address this challenge, the American Diabetes
Association's (ADA's) Overcoming Therapeutic Inertia (OTI)
initiative has developed a practical approach to addressing
patient-level barriers and resistance to therapy intensification.
Known as Critical Conversations for Overcoming
Therapeutic Inertia Framework, it provides a roadmap for
quickly surfacing and addressing issues that can lead to
unnecessary therapeutic delays. The framework aims to
promote early positive conversations about the nature of
diabetes and associated treatment that can help patients
move more smoothly along their treatment journey.
Success of these the " critical conversations " is predicated
on the implementation of certain best practices for patientcentered care. These include:
* Creating a personalized diabetes care plan for each patient
* Setting a shared A1C goal and a time frame in which to
meet it
* Consistently screening for social and emotional barriers
and subsequently making referrals to support resources,
including diabetes self-management education and
support (DSMES)
* Using a team-based approach and leveraging staff
practicing at the top of their license
Below are the four critical conversations. We encourage
you to consider incorporating these into your conversations
with patients.
1. The nature of type 2 diabetes is to change over time, as
your insulin production changes. Key messages include:
* This is not a personal failure and doesn't mean the
patient has done something wrong.
* Emphasize that diabetes is a serious disease and
indicate that you take it seriously, too.
* Although diabetes is progressive, your actions can
make a difference in slowing diabetes progression
over time.

2. Your treatment plan will change over time, as your
diabetes changes. Key messages include:
* Adding medications may be necessary as diabetes
changes.
* There are many great treatment options, and new ones
coming all the time, that can help at each stage of your
diabetes journey.
* Adding new medications is not a personal failure, but
part of how diabetes treatment progresses.
* We will work with you to find a treatment plan that both
achieves their A1C goal and considers your preferences
and values.
3. You can't do this alone. Key messages include:
* Achieving treatment goals is a team effort.
* We, your health care team, are available and ready to
help.
* Seek the help of family, friends, and community support
resources like diabetes education
4. Share your difficulties with managing your diabetes. Key
messages include:
* Managing diabetes day in and day out can be hard.
Share anything that may be getting in the way of
managing your diabetes.
* Your health care team is always here to help.
* Your health care team is on your side and will support
you in whatever ways you need to manage your
diabetes well.
The ADA has created a brief self-assessment tool that people
with diabetes used in a clinic waiting room. This tool helps
identify misperceptions
about diabetes and the
diabetes therapy journey.
It also surfaces social
and emotional barriers
for further discussion. A
provider conversation guide
accompanies with action
tips and talking points for
responding to each selfassessment response.
Download the selfassessment and
conversation guide and
try it out in your practice.

professional.diabetes.org

https://professional.diabetes.org/sites/professional.diabetes.org/files/media/ada_providerguide_final-2021-03-17.pdf https://professional.diabetes.org/sites/professional.diabetes.org/files/media/ada_providerguide_final-2021-03-17.pdf https://professional.diabetes.org/sites/professional.diabetes.org/files/media/ada_providerguide_final-2021-03-17.pdf http://professional.diabetes.org

Diabetes Pro Quarterly - Spring 2021

Table of Contents for the Digital Edition of Diabetes Pro Quarterly - Spring 2021