In this sixth episode, Dr Tebelele and Dr Mashitisho tackle the real-world challenges faced by healthcare professionals when managing diabetes, particularly when transitioning patients into insulin therapy. The session explores barriers such as therapeutic inertia, patient resistance, treatment fatigue, and resource limitations. It emphasises practical, evidence-informed strategies to overcome these obstacles in everyday clinical care.

The discussion underscores the importance of timely intensification of therapy, effective communication, and a multidisciplinary approach to ensure that both patients and clinicians remain engaged in long-term diabetes management. Dr Mashitisho provides practical insights into managing comorbidities, personalising treatment, and fostering patient adherence through empathy, education, and realistic goal-setting.

1. Identify common clinical and psychological barriers to effective diabetes management.
2. Recognise the impact of therapeutic inertia and outline strategies to overcome it.
3. Apply communication techniques that enhance patient motivation and adherence.
4. Address treatment complexity through simplified regimens and patient empowerment.
5. Collaborate with multidisciplinary teams to support continuity of care and reduce complications.

• Diagnose and manage diabetes treatment challenges systematically.
• Recognise and mitigate therapeutic inertia through proactive treatment intensification.
• Engage patients with culturally sensitive counselling to improve self-management.
• Implement simplified, patient-friendly insulin or oral-therapy regimens to enhance adherence.
• Integrate behavioural and psychosocial support into diabetes care to improve outcomes.

• Therapeutic inertia: Delays in intensifying therapy contribute to poor outcomes; clinicians should act earlier to adjust treatment.
• Patient resistance: Fear of insulin, weight gain, and lifestyle disruption remain major barriers; reassurance and education are key.
• Practical barriers: Limited consultation time, inconsistent follow-up, and affordability issues in South African settings.
• Communication strategies: Use of motivational interviewing and empathetic engagement to uncover patient concerns.
• Team-based care: The combined role of nurses, dietitians, pharmacists, and educators in supporting adherence.
• Managing comorbidities: Integrating hypertension, dyslipidaemia, and renal-care considerations into holistic treatment plans.
• Sustainability: Building long-term patient partnerships and community-based support to maintain glycaemic control.