Barriers to Control of Blood Glucose in Diabetes Mellitus

Abstract

The purpose of this study was to characterize the barriers to tight control of diabetes mellitus. The study collected data from multiple sources at a primary health care clinic in an academic teaching hospital serving an urban population, including patients' charts, structured interviews with patients, a survey of physicians' general perspectives and beliefs concerning diabetes mellitus, and a physician's structured review of barriers to tight control for individual patients. One hundred thirty-five patients with scheduled appointments were eligible for the study, of whom 94% had had a recent hemoglobin A1C (HbA1C). Seventy-seven of 88 patients (88%) who presented for their appointments consented to the interview, 48 of 50 providers (96%) returned useable surveys, and providers completed individual assessments for 96 patients (71%). Patients had a mean age of 61 years, an average of 7.60 diagnoses, and an average of 8.96 prescriptions. Their diabetes control was less than ideal, with less than 15% having normal or near normal control and almost a quarter having poor control. Correlations of HbA1C with age and show rate were seen. Physicians' assessments showed that motivation and understanding of diabetes and compliance with diet and medications correlated with diabetes control. Neither patient knowledge nor physician knowledge appeared to be a problem, nor did either correlate with diabetes control. The number of barriers to control were many, with over half of the patients having five or more barriers. Tight control of blood glucose is felt to be an important aspect of quality care for diabetic patients. In this study, a representative sample of diabetic patients had less than ideal diabetes control. This population was receiving their care in an urban setting and had many comorbid illnesses and many barriers to control. Age, motivation, understanding of the disease, show rate, and compliance with diet and medications had statistical correlations with diabetes control. In order to improve the quality of care for diabetic patients, barriers to care must be addressed.

Barriers to initiating insulin therapy in patients with type 2 diabetes mellitus in public-sector primary health care centres in Cape Town

“…13 Similar findings have also been reported from the USA. [14][15][16][17][18] As attainment of good glycaemic control is critical to improving outcomes in people with diabetes, this qualitative study was conducted to identify and explore barriers to the initiation of insulin therapy in patients with poorly controlled type 2 diabetes who are being prescribed maximum doses of oral medication by MOs in community health centres (CHCs) in the Cape Town metropole. These 44 CHCs are run by the Community Health Services Organisation (CHSO) of the Department of Health of the Provincial Administration of the Western Cape (PAWC) and provide comprehensive primary services for a population of 3 million in the Cape Town metropole.…”

External Barriers to Diabetes Care: Addressing Personal and Health Systems Issues

“…35,36 Another concern reported by physicians was that patients do not have a sense of urgency or understanding about treating their diabetes and thus are less likely to adhere to provider recommendations. [35][36][37] Physicians also reported that there was not adequate administrative support for the increased time and effort required to treat diabetic patients. 35,36 Additionally, patient finances were viewed by physicians as a barrier to diabetes care 38 and adequate glycemic control.…”

Efficacy of intensive multitherapy for patients with type 2 diabetes mellitus: a randomized controlled trial

“…The success of permanent lifestyle changes is dependent on patients' degree of motivation, psychosocial condition, risk profile and compliance: patient nonadherence to the lifestyle regimen is the most common barrier to care. 29,30 Further studies are required to determine the best process for inducing long-lasting change in behaviour in type 2 diabetic patients. The Diabetes Control and Complications Trial, which studied intensive management of type 1 diabetes, also reported post-intervention worsening, but this occurred 4 years after the intervention.…”