HCP–patient relationships and patient support are key to successful management of long-term conditions such as diabetes. As a result of time constraints experienced by providers, patients are often provided with written educational materials without associated interaction, explanation, and encouragement, which have limited effects. Studies have shown that inadequate health literacy can be associated with poor glycemic control, highlighting the need to go beyond written educational material [
33‐
35]. A national literacy assessment in the USA in 2003 concluded that only 12% of the population had proficient health literacy and 35% had a basic or below basic level of health literacy [
36]. Patient education and support sought through a Certified Diabetes Educator (CDE) is therefore important and may be more successful at addressing clinical inertia. In a recent Canadian study that investigated barriers to care in patients with T2D, the majority of patients with poor glycemic control reported that they did not feel the need for more information regarding the management of diabetes. Their reluctance to acquire and use this information may also be reflected by their reported lack of confidence in their ability to follow through and adhere to treatment [
37].
Regular HCP–patient contact and patient-centered, non-judgmental discussions that provide intellectual and emotional support can help overcome patient barriers to adhering and intensifying treatment. Resistance to change can be managed by identifying patient obstacles and actively addressing each one by challenging beliefs, reassuring the patient, and describing reports of positive experiences from patients undergoing the same treatment regime. It is essential that patients understand that diabetes is a progressive disease, and that the addition or intensification of treatment, especially with insulin, is not a failure on their part, but a logical and necessary means of addressing the normal decline in pancreatic function associated with their disease [
5,
15,
27]. In a systematic review that included 118 unique diabetes self-management education (DSME) interventions, patients with T2D who received DSME had an average A1C reduction of 0.57%, demonstrating significant improvements in glycemic control compared to those who did not [
38]. Giving praise after improvements in glycemic control and reminding patients of the associated clinical benefits can also help motivate patients [
5]. Reluctance to escalate treatment and non-compliance may stem from a lack of knowledge regarding the severity of uncontrolled diabetes and the urgency of reducing A1C levels and maintaining glycemic control. A recent study demonstrated that physicians were most interested in complications with high rates of mortality, such as cardiovascular disease, whereas patients were more concerned about complications such as retinopathy and nephropathy that would have an impact on the quality of daily living [
39]. Patients are more likely to accept and adhere to treatment if they perceive it is contributing to a positive outcome and addressing a need [
40]. Therefore, a proactive rather than reactive approach is important in managing patients with diabetes. Emphasis on the association between good glycemic control and lifestyle changes (i.e., diet and exercise) with reduced incidence of complications may prove successful towards improving patient engagement [
39]. Moreover, patient fears concerning the negative impacts of certain medications (e.g., use of needles, long-term risks, side effects, treatment complexity, etc.), which may outweigh any benefits, must be addressed [
40]. Finally, where the available choices of diabetes medications are similarly efficacious, individualized therapy should be matched to patient preference with respect to convenience, specific side effects, daily dosing schedules, and out-of-pocket costs in parallel to glycemic control [
41].