Type 2 diabetes (T2D) progresses over time, and to achieve and maintain adequate glucose control, many people eventually require injectable therapies such as insulin. However, there can be significant barriers to the initiation of these medications, both from people living with T2D and from healthcare practitioners (HCPs). Misconceptions and misinformation relating to the potential risks and benefits of injectable therapies are common and can contribute to negative perceptions regarding their use. Additionally, HCPs are often unaware of the emotional burden associated with T2D. In particular, diabetes distress is a key contributory factor that needs to be addressed to alleviate fears before diabetes education can be successful. The onus is often on the HCP to initiate effective, individualized communication with each patient and make that person feel an active and equal participant in the management of their T2D. Shared decision-making has been demonstrated to improve understanding of the pathophysiology and treatment options, to increase risk awareness, adherence, and persistence, and to improve self-management behaviors (e.g., exercise, self-care) and patient satisfaction. While therapeutic inertia can result from both patient and HCP, HCPs need to bear the responsibility for escalating therapy when necessary. A proactive approach by the HCP, combined with shared decision-making and a patient-centric approach, are important for optimal T2D management; therefore, an open and effective relationship between the HCP and the person living with T2D is essential. This article is written by a person with T2D, a nurse practitioner/Certified Diabetes Care and Education Specialist, and a clinical endocrinologist, with the goal of providing a holistic view of the management experience, exploring patient needs and expectations, recognizing and avoiding HCP and patient barriers, and providing practical advice to HCPs to empower patients who would benefit from injectable therapy.Infographic and video abstract available for this article.
Keywords: Barriers; Communication; HCP; Insulin; Type 2 diabetes.
Type 2 diabetes can be managed with diet, exercise, and medicines. As type 2 diabetes progresses, the most effective treatment may change, and people may need to start taking insulin or other injections to manage their blood sugar. However, many people do not receive the information needed to understand why their type 2 diabetes has progressed or why they need to change treatment. Also, they may have received inaccurate information about the risks and benefits of insulin injections. The demands of managing type 2 diabetes can have an emotional impact (known as diabetes distress), which can lead to anxiety and make people reluctant to engage in their own care or start new medications. Healthcare professionals need to recognize the impact of diabetes distress so that they can help people with type 2 diabetes overcome these barriers. Understanding the factors driving the behaviors of people with type 2 diabetes and encouraging them to ask questions can help them overcome concerns about changing treatment. This is most likely to be achieved when people with diabetes are actively involved in treatment decisions. This article, written by a person with type 2 diabetes and two healthcare professionals, aims to provide practical guidance for healthcare professionals to recognize the emotional impact of diabetes, and to understand how this affects a person’s ability to manage their condition. This article also provides advice on how to improve communication with patients and to provide effective diabetes education to meet the needs of people living with type 2 diabetes. In this video, the authors, a person with T2D, a nurse practitioner/certified diabetes care and education specialist, and a clinical endocrinologist, provide practical guidance for healthcare professionals. They focus on how to recognize the emotional impact of diabetes, understand how this affects a person’s ability to manage their condition, how to improve communication with patients, and how to provide effective diabetes education to meet the needs of people living with type 2 diabetes, with an emphasis on the initiation and use of injectable therapy.
© 2022. The Author(s).