The SELFIE 2.0 project (SELF assessment for the therapeutic appropriateness in people with diabetes): proposals to impro­vethe approach to therapeutic intensification in patients with type 2 diabetes with inadequate metabolic control

The SELFIE project (SELF assessment for therapeutic appropriateness in people with diabetes) was designed to collect the perceptions and opinions of 60 diabetologists in 12 territorial meetings. The objective was to launch the debate between experts through a structured discussion procedure to identify the main “barriers to intensification” of diabetes treatment (first phase) and the “possible solutions” (second phase). The discussion took into account that DPP4-inhibitors prescription still requires a “therapeutic schedule” in Italy. So, the specific barriers of 8 different profiles (phenotypes) of patients with inadequate metabolic control, classified in terms of age, renal function and treatment with one or more glucose-lowering drugs were highlighted. This article summarizes the results of the second phase. Optimizing / simplifying drug therapy, establishing a therapeutic alliance with the patient, involving a caregiver to act on motivation / communication with the patient, improving organizational aspects, reducing bureaucracy and stimulating the doctor’s attitude to change are the key points that emerged as crucial for overcoming clinical inertia. Implementation of these solutions based on their applicability to the different phenotypes was debated though standardized discussion procedures. Implementing these solutions, monitoring their adoption and measuring the results obtained in the short- and long term, simultaneously focusing on the training of patients and healthcare professionals, is a challenge for the entire diabetes community, to improve the care provided and the clinical outcomes. KEY WORDS type 2 diabetes; glycemic targets; therapeutic inertia; DPP-IV inhibitors; professional education.