Exploring Approaches to Facilitate Diabetes Therapy Intensification in Primary Care

Several landmark studies have provided strong support for the position that vigorous treatment of diabetes in the majority of individuals has the potential to reduce the morbidity and mortality of the disease by decreasing its chronic complications (1,2). In response, many advances have been made that include the introduction of highly successful therapies and tools such as more effective medications, blood glucose meters, insulin delivery systems, and needle sizes. Yet, despite this progress, people with diabetes can still have challenges in meeting target goals (3,4) and experience distress related to their treatment plan (5–7). Intensive therapies that have been shown to prevent or slow the progression of complications require people with diabetes to learn and maintain demanding, complex selfcare routines. These therapies and routines are often met with fear and reluctance, and adhering to them can be difficult (5,7,8). Furthermore, providers report challenges in introducing advanced therapies for people with diabetes. A survey of physicians’ attitudes found that primary care providers (PCPs) consider diabetes more difficult to treat than other chronic diseases because it requires more monitoring and medication adjustment to achieve treatment goals (9). Physicians also report that there is inadequate support for the increased time and effort required to treat diabetes patients and that neither clinics nor patients can afford what it takes for comprehensive care (9–11). Diabetes self-management education and support (DSME/S) have repeatedly been shown to improve clinical, behavioral, and psychosocial outcomes (12–14). In addition, DSME/S are reported to reduce the onset or advancement of diabetes complications (15), improve quality of life (16,17), enhance self-efficacy and empowerment (18,19), increase healthy coping (20), and decrease the presence of diabetes-related distress (21,22) and depression (23,24). Most recently, DSME/S provided in the primary care setting have been shown to improve processes and patient outcomes (25–27). To overcome barriers to better diabetes outcomes, new approaches must be explored when introducing therapies into practice. Diabetes educators (DEs) can play a pivotal role in educating and supporting both patients and providers in the adoption and delivery of therapies. Although previous studies have identified barriers to diabetes care, no recent studies have explored insights that offer the potential to directly inform the practice of diabetes education and advancement of diabetes therapies in primary care. Based on provider interviews and patient focus group findings from the first phase of this study (11), the objectives of the subsequent phases (reported here) were 1) to develop and assess the usefulness of an educational program on therapy intensification delivered by DEs Exploring Approaches to Facilitate Diabetes