Diabetes Pro Quarterly - Summer 2022 - 15

Professional News
Just Released: Free Overcoming Therapeutic Inertia Resources
New resources are available to
you and your colleagues from the
Overcoming Therapeutic Inertia (OTI)
initiative. These materials, created by
the American Diabetes Association's
(ADA's) OTI Work Group, can be
downloaded for free at the OTI home
page on the ADA's website. The
following resources are available.
* An infographic highlighting best
practices, based on the initiative's
2021 meta-analysis, that can be
applied at the practice, health care
professional, and patient levels
Make a Difference:
Achieve Glycemic Goals Early in
Patients with Type 2 Diabetes
With These Best Practice Strategies
Intensify Treatment of Newly Diagnosed Patients and Patients with A1C Above Target
Early and appropriate therapy improves patients'
chances of reaching A1C goals.
The Legacy Effect: Landmark clinical trials and
research studies show that reaching A1C targets in
the first year of treatment results in sustained,
long-term health improvements even when control
waned over time1-7
.
Achieve glycemic goals in < 6-12 months
" The work group wanted to create
resources that highlight easy-toimplement
solutions at the health care
professional and health system level, "
Chris Beebe, MS, RD, CDE, co-leader
of the OTI initiative, said. " These new
materials, along with others on the
OTI website, will empower health
care professionals to be champions in
delivering guideline-directed diabetes
care in daily practice. "
Create Personalized Diabetes Care Plans
Assess patient's:
Health literacy and numeracy
Attitudes and beliefs regarding
medication therapy
Social determinants of health
Have ongoing conversations about
the progressive nature of type 2
diabetes and management options.
Diabetes changes over time and
therefore their treatment plan will
change too
Implement a Team-Based Approach
Empower the appropriate team
members to independently initiate
and adjust medications.
Use medication algorithms and
protocols for therapeutic changes
Effective team communication
Refer to:
Diabetes self-management
education and support
specialist
Registered dietitian
Pharmacist
Behavioral health specialist
Improve A1C by leveraging
the multidisciplinary team
A recent systematic review and
meta-analysis8
found that, compared
to usual care, interventions where
non-physician providers initiate and
intensify treatment, with support
from guidelines, had greater
reductions in A1C.
Nurse- or Certified
Diabetes Care & Education
Specialist-led medication
management
Care management &
patient education
interventions
Pharmacist-based
interventions
Physician-based
interventions
Reductions in A1C compared to usual care8
-0.40% to -1.62%
-0.30% to -1.20%
:
-0.60% to -0.90%
-0.26% to -0.40%
Trained community
health worker
Other diabetes care
team members
Use shared decision making to
determine individual glycemic
targets and how to achieve glycemic
targets within 3-6 months.
Results may be less dependent on who intensifies therapy but rather how they intensify. Frequency of contact and delivery methods matter. Nearly all care
management and patient education interventions resulting in statistically and clinically significant reduction in A1C used technology to communicate with patients.8
* An advocacy presentation that can
be shared with hospital or health
system executives and summarizes
the business case for implementing
system-level changes in diabetes
care to improve health outcomes and
efficiencies
Leverage Tools and Technology
My Glucose
GLUCOSE IN RANGE
125
350
250
150
50
2pm
6pm
10pm
1m ago
mg/dL
125
350
250
150
50
2pm
6pm
10pm
mg
dL
Use technology for glycemic assessments to adjust
therapy before/between 3-month A1C checks.
Blood glucose monitoring data
Continuous glucose monitoring data
Patient self-tracking tools and support apps
Use electronic health records to identify high risk
patients and implement guidelines
Communicate frequently with patients.
Patient-provider portals
HIPAA-compliant texting modalities
Telehealth visits where appropriate
Schedule diabetes-only visits
Use team members to increase touchpoints
Utilize patient registries and chronic care coordinators
Take Action to Bust Therapeutic Inertia!
Therapeutic inertia is the inaction of the clinician
to intensify or de-intensify treatment when A1C
goals are not met.
Learn more and access tools to implement these
strategies from the Overcoming Theraputic Intertia
initiative from the American Diabetes Association
at therapeuticinertia.diabetes.org
* An implementation guide that can
be shared in grand rounds and team
trainings to help you and your team
explore best practices and develop
strategies to overcome therapeutic
inertia in your organization.
References: 1. Holman RR, et al. N Engl J Med. 2008; 359: 1577-1589 2. Laiteerapong N, Ham S, Goo Y, et al. Diabetes Care 2019;42:416-0426 3. Mehta R, et al. Journal of
Clinical & Translational Endocrinology. 19(2020) 100215 4.ADA Standards of Care 2022 5.Khunti K, et al. Diab Care 2013;36:3411-7;6. Del Prato S, et al. Int J Clin Pract
2005;59:1345-1355 7. UKPDS 33. Lancet. 1998; 352: 837-853 8. Powell RE, et al. Diabetes Obes Metab. 2021;23:2137-2154.
Several collaborating associations,
including the Association of Diabetes
Care & Education Specialists,
American Association of Nurse
Practitioners, American Academy
of Physician Associates, American
Medical Group Association, American
Pharmacists Association, and
American Society of Health-System
Pharmacists, have created or
disseminated additional OTI resources
in the past few months. ADA has
developed webinars, videos, and
handouts and disseminated them to
these association partners.
" It will take the entire diabetes
care team if we want to overcome
therapeutic inertia, " OTI Research
Work Group leader Kamlesh Khunti,
MD, PhD, said. " These association
partners have contributed to this
initiative's strategy and worked to
increase awareness and education of
this important issue. "
ADA would like to thank its
entire OTI Work Group for their
contributions to these resources.
The work group includes:
* Nay Linn Aung, MD, BC-ADM
* Christine A. Beebe, MS, RD
* Stephen A. Bunton, MD
* Andrew Bzowyckyj, PharmD, BCPS,
CDCES
* Doreen Cassarino, DNP, APRN, FNPBC,
BC-ADM, FAANP, FNAP
* Mehta Chhavi, MD
* John Cuddeback, MD, PhD
* Nicholas Cuttriss, MD, MPH, FAAP
* Sumit Dutta, MD
* Kamlesh Khunti, MD, PhD
* Amanda Klein, PharmD
* Shannon Knapp, BSN, RN, CDE
* Jodi Lavin-Tompkins, MSN, RN,
CDCES, BC-ADM
* Sandra Leal, PharmD, MPH
* Michelle L Litchman, PhD, FNP-BC,
FAANP
* Dave Marerro, PhD
* Rajesh Mehta, RPh
* Eden Miller, DO
* Joy A. Moverley, DHSc, MPH, PA-C
* Lucia Novak, MSN, ANP-BC, BCADM,
CDTC
* Dhiren Patel PharmD, CDE, BCADM,
BCACP
* Eric Peterson, EdM, CHCP, FACEHP
* Anthony Pick, MD
* Douglas Scheckelhoff, M.S., FASHP
* Jessica Skelley, PharmD
* Daniel Zlott, PharmD, BCOP
The OTI initiative is supported in part
by strategic sponsors AstraZeneca
and Sanofi US Services, Inc., and
supporting sponsors Merck and
Novo Nordisk, Inc. Visit the OTI
home page to learn more about this
important initiative.
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professional.diabetes.org 15

Diabetes Pro Quarterly - Summer 2022

Table of Contents for the Digital Edition of Diabetes Pro Quarterly - Summer 2022