Ways to Address or Prevent Therapeutic Inertia for People With Type 1 or Type 2 Diabetes
When to Use Injectable Therapy in Type 2 Diabetes
Use of Glucose-Lowering Medications in the Management of Type 2 Diabetes
The left side of the algorithm prioritizes mitigation of diabetes-related complications and end-organ effects, while the right side addresses weight and glucose management goals. ACEi, angiotensin-converting enzyme inhibitor; ACR, albumin-to-creatinine ratio; ARB, angiotensin receptor blocker; ASCVD, atherosclerotic cardiovascular disease; CGM, continuous glucose monitoring; CKD, chronic kidney disease; CV, cardiovascular; CVD, cardiovascular disease; CVOT, cardiovascular outcomes trial; DPP-4i, dipeptidyl peptidase 4 inhibitor; eGFR, estimated glomerular filtration rate; GIP, glucose-dependent insulinotropic polypeptide; GLP-1 RA, glucagon-like peptide 1 receptor agonist; dual GIP/GLP-1 RA, dual glucose-dependent insulinotropic polypeptide and glucagon- like peptide 1 receptor agonist; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; HHF, hospitalization for heart failure; MACE, major adverse cardiovascular events; MI, myocardial infarction; SDOH, social determinants of health; SGLT2i, sodium-glucose cotransporter 2 inhibitor; T2D, type 2 diabetes; TZD, thiazolidinedione. Adapted from Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2022;45:2753–2786.
The left side of the algorithm prioritizes mitigation of diabetes-related complications and end-organ effects, while the right side addresses weight and glucose management goals. ACEi, angiotensin-converting enzyme inhibitor; ACR, albumin-to-creatinine ratio; ARB, angiotensin receptor blocker; ASCVD, atherosclerotic cardiovascular disease; CGM, continuous glucose monitoring; CKD, chronic kidney disease; CV, cardiovascular; CVD, cardiovascular disease; CVOT, cardiovascular outcomes trial; DPP-4i, dipeptidyl peptidase 4 inhibitor; eGFR, estimated glomerular filtration rate; GIP, glucose-dependent insulinotropic polypeptide; GLP-1 RA, glucagon-like peptide 1 receptor agonist; dual GIP/GLP-1 RA, dual glucose-dependent insulinotropic polypeptide and glucagon- like peptide 1 receptor agonist; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; HHF, hospitalization for heart failure; MACE, major adverse cardiovascular events; MI, myocardial infarction; SDOH, social determinants of health; SGLT2i, sodium-glucose cotransporter 2 inhibitor; T2D, type 2 diabetes; TZD, thiazolidinedione. Adapted from Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2022;45:2753–2786.
To-Do List for Clinicians Treating People With Insulin Therapy
Provide or refer people with diabetes and caregivers for education about injection technique and timing and problem-solving for issues related to insulin therapy (e.g., hypoglycemia, missed or incorrect doses, and dose adjustments).- Ensure that individuals have all supplies necessary for injections (e.g., pen needles for insulin pens or appropriate syringes for insulin dose size or concentration when using insulin in vials) and glucose monitoring.
- Evaluate individuals with type 2 diabetes to determine whether they are candidates for GLP-1 or dual GIP/GLP-1 RA therapy.
- Evaluate all people on insulin therapy to determine whether they could benefit from continuous glucose monitoring.
- Ensure that people on insulin therapy have the education and supplies needed to prevent and treat hypoglycemia, including glucagon, glucose monitoring supplies, and appropriate sources of carbohydrates to treat low glucose levels.
- Schedule timely and routine follow-up visits to reassess therapy and adjust care plans to avoid therapeutic inertia.
