Review
Barriers to diabetes management: Patient and provider factors

https://doi.org/10.1016/j.diabres.2011.02.002Get rights and content

Abstract

Despite significant advances in diagnosis and treatment, the persistence of inadequate metabolic control continues. Poor glycemic control may be reflected by both the failure of diabetes self-management by patients as well as inadequate intervention strategies by clinicians. The purpose of this systematic review is to summarize existing knowledge regarding various barriers of diabetes management from the perspectives of both patients and clinicians. A search of PubMed, CINAHL, ERIC, and PsycINFO identified 1454 articles in English published between 1990 and 2009, addressing type 2 diabetes, patient's barriers, clinician's barriers, and self-management. Patients’ adherence, attitude, beliefs, and knowledge about diabetes may affect diabetes self-management. Culture and language capabilities influence the patient's health beliefs, attitudes, health literacy, thereby affecting diabetes self-management. Other influential factors include the patient's financial resources, co-morbidities, and social support. Clinician's attitude, beliefs and knowledge about diabetes also influence diabetes management. Clinicians may further influence the patient's perception through effective communication skills and by having a well-integrated health care system. Identifying barriers to diabetes management is necessary to improve the quality of diabetes care, including the improvement of metabolic control, and diabetes self-management. Further research that considers these barriers is necessary for developing interventions for individuals with type 2 diabetes.

Section snippets

Methods

We searched the PubMed, CINAHL, ERIC, and PsycINFO for the years January 1, 1990–June 1, 2009 using the key words: type 2 diabetes; diabetes mellitus; barriers; diabetes self-management; treatment guidelines; adherence; and diabetes care. Reference lists of relevant studies were also hand searched for additional sources. The goal of this review was not to perform a meta-analysis. Thus, a search for systematic review included cross-sectional studies; randomized clinical trials (RCTs);

Patient factors

Adherence: Better adherence to a self-care regimen, a characteristic of active patient self-management, can reduce mortality and disability, improve quality of life, and reduce health care costs [5], [6], [7]. Glycemic control is affected by poor patient adherence to treatment regimens, for example, failure to keep appointments or take medications as recommended [8]. Several studies compared cohorts with different medication adherence regimens. Once-daily regimens had higher rates of adherence

Discussion and conclusions

Effective type 2 diabetes management is widely acknowledged as challenging for both patients and their health care providers.

Several patient factors may contribute to type 2 diabetes management: adherence, beliefs, attitudes, knowledge, ethnicity/culture, language ability, financial resources, co-morbidities, and social support. Seven studies found that adherence to self-management are influenced by an individual's financial resources, beliefs and attitudes about the disease, and effectiveness

Conflict of interest

The authors declare that they have no conflict of interest.

Acknowledgements

Acknowledgment of financial and/or other support: California Endowment and American Association of Colleges of Nursing (AACN), Nurse Faculty Program, 2007–2009.

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