Identification of the Inappropriate Clinical Actions (DON'T) to Improve the Management of Patients with Type 2 Diabetes Failing Basal Insulin Supported Oral Treatment: Results of Survey for a Panel of Diabetes Specialists in Italy

Gaetano Leto; Ilaria Barchetta; Lorenzo De Candia; Maria Grazia Magotti; Marco Cianciullo; Roberta Manti; Carlo Negri; Vincenzo Cimino; Alessandro R Dodesini; Francesco Zerella; Roberto Baratta

doi:10.1007/s13300-021-01137-4

Identification of the Inappropriate Clinical Actions (DON'T) to Improve the Management of Patients with Type 2 Diabetes Failing Basal Insulin Supported Oral Treatment: Results of Survey for a Panel of Diabetes Specialists in Italy

Diabetes Ther. 2021 Oct;12(10):2645-2661. doi: 10.1007/s13300-021-01137-4. Epub 2021 Aug 20.

Authors

Affiliations

¹ Diabetology Unit, Sapienza University of Rome, Polo Pontino, Santa Maria Goretti Hospital, Latina, Italy. gaetano.leto@uniroma1.it.
² Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
³ Diabetology Clinic, Hospital of Terlizzi, Bari, Italy.
⁴ Department of Intensive Treatment of Diabetes and its Complications, University Hospital of Parma, Parma, Italy.
⁵ Department of Medicine, Nocera Inferiore Hospital, Salerno, Italy.
⁶ Diabetology Unit, Santa Croce Hospital of Moncalieri, Turin, Italy.
⁷ Department of Diabetology and Metabolic Diseases, Hospital of Verona, Verona, Italy.
⁸ Department of Biomedical and Clinical Sciences L. Sacco Endocrinology and Diabetology, Pio Albergo Trivulzio, Milan, Italy.
⁹ Diabetology and Endocrine Diseases Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy.
¹⁰ Diabetology, Metabolic Diseases and Clinical Nutrition, San Pio Rummo Hospital of Benevento, Benevento, Italy.
¹¹ Endocrinology and Diabetology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.

Abstract

Introduction: Despite the development of several recommendations, glycemic control in a large proportion of patients with type 2 diabetes, including those treated with insulin, remains suboptimal. This study is aimed to identify a set of actions to promote the reduction of inappropriate clinical practices in type 2 diabetes failing basal insulin supported oral therapy (BOT).

Methods: A panel of diabetes specialists was assembled to identify a list of ten corrective actions, "things not to do," for the management of type 2 diabetes: five concerning treatments, procedures and diagnostic tests and five about relationship, communication and information. The Choosing Wisely methodology and approach were the inspiration.

Results: A total of 73/73 (100%) panelists responded to the survey. Twenty-four actions were proposed. The final list of inappropriate actions deemed most important to improve the management of patients with type 2 diabetes failing BOT were: (1) do not use secretagogues-do not neglect the use of innovative glucose-lowering agents; (2) do not underestimate the risk of lack of hypoglycemia awareness; (3) do not underestimate the benefit of personalization of therapy; (4) do not delay insulin intensification; (5) do not delay modification of the therapeutic regimen. In the area of patient communication, the following actions were identified: (1) do not fail to train in the management of hypoglycemia; (2) do not underestimate whether the patient has understood the modification of therapy; (3) do not prescribe injection therapy without adequately instructing the patient to titrate it; (4) do not ignore the patient's adherence; (5) do not stop listening to the patient and verify learning.

Conclusion: A set of corrective experience-based actions to enact in a timely manner, which can assist physicians in improving clinical outcomes and patients' needs in terms of communications and interaction, is proposed. The list is intended to promote discussions among diabetes specialists to provide high-value diabetes care.

Keywords: Basal insulin supported oral therapy; Patient communication; Treatment intensification; Type 2 diabetes.