Monograph: Addressing Clinical Inertia and Patient Needs with Complementary Insulin-Based Therapies
This JAAPA supplement monograph outlines effective treatment practices for patients with T2DM. Also available, Clinical Dialogue and eCase Challenge: Addressing Clinical Inertia and Patient Needs with Complementary Insulin-Based Therapies.

Addressing Clinical Inertia and Patient Needs with Complementary Insulin-Based Therapies

Lawrence Herman, MPA, PA-C, DFAAPA; Amy E. Butts,
PA-C, MPAS, CDE; Ashlyn Smith, PA-C, MMS

Efforts to reduce PA clinical inertia and increase patient acceptance of combination injectable therapy when basal insulin is no longer sufficient to maintain euglycemia is paramount to improving outcomes for patients with Type 2 Diabetes Mellitus (T2DM). Most PAs feel more comfortable starting the first injectable therapy – typically insulin or the glucagon-like peptide-1 receptor agonists (GLP-1 RA), but not in starting a second injectable therapy. The main barriers to initiating additional injectables are related to the complexity of more than one injectable drug, and the lack of comfort with complex patient profiles, namely patients with difficultly achieving glycemic control. 

The progressive nature of T2DM eventually leads to the use of basal insulin and the need for its use in combination with other agents to address postprandial hyperglycemia. Earlier use of insulin produces clinical and cost benefits due to its efficacy and treatment scalability at an acceptable cost.

Achieving quality care measures and patient-centered care relies on addressing patient barriers and using features of the shared decision-making process.

PAs are in an ideal position to support patients in switching to new therapies to help normalize blood glucose levels, reduce hypoglycemic events, overcome the psychosocial barriers to initiating injectable therapy and understanding the benefits of a different therapy.

Educational Objectives

At the conclusion of this activity, the PA should be better able to:

  • Implement the most effective treatment practices for patients with T2DM that can achieve quality measures to improve patient outcomes and reduce the incidence of adverse healthcare-associated conditions and costs while meeting patient needs.
  • Identify treatment options that can achieve the trifecta of glycemic control, with low risks of hypoglycemia, avoidance of weight gain, and work with patients to minimize clinical inertia.
  • State why early combination therapy for patients with substantial elevation of A1C levels, or A1C levels not at goal despite normal fasting plasma glucose at goal, is appropriate and safe for T2DM patients.
  • Integrate shared decision making into practice and involve patients in the decision-making process regarding treatment goals, treatment options, and flexibility.

Accreditation Statement

This activity has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 1.50 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation. Approval is valid through June 30, 2019.

Responsibility Statement

AAPA takes responsibility for the content, quality, and scientific integrity of this CME activity.

Disclosure Policy Statement

It is the policy of AAPA to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member has with the commercial interest of any commercial product discussed in an educational presentation. The participating faculty reported the following:


Lawrence Herman, MPA, PA-C, DFAAPA
Associate Program Director, Adjunct Professor
University of Texas Medical Branch - Galveston
PA Studies
Galveston, TX
Disclosures: Consultant - Novo Nordisk; Speaker’s Bureau - Novo Nordisk

Amy E. Butts, PA-C, MPAS, CDE
Weirton Medical Center
Weirton, WV
Disclosures: Honorarium: Valeritas; Speaker’s Bureau: Janssen

Ashlyn Smith, PA-C, MMS
Endocrinology Associates
Scottsdale, AZ
Secretary, American Society of Endocrine PAs
Adjunct Assistant Professor
Midwestern University
Glendale, AZ

Disclosures: Advisory Board: Intarcia Therapeutics

Activity Planners

Michael Speidel, Jennifer Gregg, PhD, and Joanne Jeffers, Medical Logix, LLC have no relationship with any commercial interests whose products or services may be mentioned during this presentation.

AAPA Staff Activity Planners

Daniel Pace has no relationship with any commercial interests whose products or services may be mentioned during this presentation.

Off-Label/Unapproved Product(s) Discussion

There are no references to off-label/unapproved uses of products in this program.


The opinions and comments expressed by faculty and other experts, whose input is included in this program, are their own. This enduring material is produced for educational purposes only. Please review complete prescribing information of specific drugs mentioned in this program including indications, contraindications, warnings, and adverse effects and dosage before administering to patients.

Acknowledgement of Commercial Support

Supported by an independent educational grant from Sanofi.

AAPA offers no returns or refunds for online CME activities purchased through the AAPA store. All sales are final.

Type:     Internet Activity (Enduring Material)
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