The Refractory Patient—Managing Diabetes by the Ear

Refractory, or ‘difficult to control,’ diabetes is a commonly encountered condition in specialist practice. This editorial describes the characteristics of people with diabetes who are unable to achieve optimal glycemic control, despite aggressive drug therapy. It reflects upon the importance of bidirectional communication between patient and physician, and highlights the need for systematic history taking, empathic listening, and therapeutic patient education. The editors call for practicing ‘diabetes therapy by the ear,’ in conjunction with evidence-based pharmacological therapy, to help reduce the prevalence of refractory diabetes.