Difficult diabetes: the 7d approach.

ABSTRACT

This communication describes a 7D approach to the assessment and management of 'difficult' or refractory type 2 diabetes. It lists 7 aspects of care, which may contribute to refractoriness of hyperglycaemia, and classifies them according to a bio-psychopharmacological triad. The biomedical aspects to be addressed include diagnosis of the type of diabetes and exclusion of comorbid disease. Psychosocial factors of importance include establishing effective dialogue with the patient, ensuring discipline in daily lifestyle, and minimizing diabetes related distress. Pharmacological factors which may cause difficulty in management pertain to inappropriate choice of drug or delivery device. A simple 7D checklist of factors which may lead to uncontrolled hyperglycaemia and indicate need for insulin therapy is also presented. The bio-psychopharmacological 7D approach serves as a simple, yet comprehensive, learning tool to help improve diabetes care.