Clinical pearls and strategies to optimize patient outcomes

Increasing evidence suggests that a large proportion of patients with type 2 diabetes do not meet glycemic targets. Early diagnosis, realistic goal setting, improved patient adherence, and a better understanding of the pharmacotherapeutic treatment options are crucial to improving diabetes treatment outcomes in the United States. There are many reasons why patients do not achieve glycemic control. Barriers faced by clinicians, such as clinical inertia, lack of education time, and inappropriate use and titration of medications, need to be overcome to improve patient care. At the same time, patients are challenged by lifestyle management, lack of understanding of therapeutic options, and failing to see themselves as partners in their own care. Successful diabetes management programs incorporate several key features, including proactive reminders, consistent follow-up procedures, and use of clinical information systems to improve patient adherence and overall quality of care. Both clinicians and patients face barriers to advancing to injectable medications. Patients' attitudes may include fears of injections, technical challenges, and "punishment" for "failing" treatment. Clinicians have concerns about inadequate resources to address the needs of patients, patient nonadherence, and hypoglycemic events associated with certain injectable medications. Many of the strategies to overcome these barriers are reviewed.