Main Article Content
Diabetes Mellitus (DM) is a chronic disorder resulting from the deficiency of insulin in the body, disturbance of insulin action or both, resulting in high blood glucose levels causing long term complications.
Diabetes is well known to increase cardiovascular risk because of its association with obesity, sedentary life style, hypertension, hyper or dyslipidemia and a tendency to develop thrombosis. Diabetic patients can have poor quality of life and reduced life expectancy due to its long term macro-vascular and micro-vascular complications. The aim of this article is to highlight the many barriers to patients’ engagement in their management of diabetes and the ways how they can be overcomed.
The author during day to day practice came across many barriers while managing diabetic patients. Extensive searches were done on electronic databases like MEDLINE/PubMed and google scholar, with medical headings diabetes, type 2 diabetes and barriers to management.Diabetes mellitus
National Institute for Health and Care Excellence (NICE). Type 2 diabetes: the management of type 2 diabetes CG87. London; 2014.
World Health Organization (WHO). Prevention and control of noncom-municable diseases: Guidelines for primary health care in low-resource settings. Geneva; 2020.
Rushforth B, McCrorie C, Glidewell L, Midgley E, Foy R. Barriers to effective management of type 2 diabetes in primary care: Qualitative systemic review. Br J Gen Pract. 2016;66(643):e114–e127.
Noor Abdulhadi NM, Al-Shafaee MA, Wahlström R, Hjelm K. Doctors’ and nurses’ views on patient care for type 2 diabetes: An interview study in primary health care in Oman. Prim Health Care Res Dev. 2013;14(3):258–269.
Agarwal G, Nair K, Cosby J, Dolovich L, Levine M, Kaczorowski J, Butler C, Burns S. GPs’ approach to insulin prescribing in older patients: A qualitative study. Br J Gen Pract. 2008;58(553):569–575
Crosson JC, Heisler M, Subramanian U, Swain B, Davis GJ, Lasser N, Ross S, Schmittdiel JA, Onyemere K, Tseng CW. Physicians’ perceptions of barriers to cardiovascular disease risk factor control among patients with diabetes: results from the translating research into action for diabetes (TRIAD) study. J Am Board Fam Med. 2010;23(2):171–8.
Haque M, Navsa M, Emerson SH, Dennison CR, Levitt NS. Barriers to initiating insulin therapy in patients with type 2 diabetes mellitus in public-sector primary health care centres in Cape Town. S Afr Med J. 2005;95(10):798–802.
Larme AC, Pugh JA. Attitudes of primary care providers toward diabetes: barriers to guideline implementation. Diabetes Care. 1998;21(9):1391–1396.
Jeavons D, Hungin AP, Cornford CS. Patients with poorly controlled diabetes in primary care: healthcare clinicians’ beliefs and attitudes. Postgrad Med J. 2006; 82(967):347–350
Abbott S, Burns J, Gleadell A, Gunnell C. Community nurses and self-management of blood glucose. Br J Community Nurs. 2007;12(1):6–11.
Burden ML, Burden AC. Attitudes to starting insulin in primary care. Practical Diabetes International. 2007;24(7):346–350.
Wens J, Vermeire E, Van Royen P, Stabbe B, Denekens J. GPs’ perspectives of type 2 diabetes patients’ adherence to treatment: A qualitative analysis of barriers and solutions. BMC Fam Pract. 2005;6(1): 20.
Alberti H, Boudriga N, Nabli M. Primary care management of diabetes in a low/ middle income country: A multi-method, qualitative study of barriers and facilitators to care. BMC Fam Pract. 2007;8:63.
Raaijmakers LG, Hamers FJ, Martens MK, Bagchus C, de Vries NK, Kremers SP. Perceived facilitators and barriers in diabetes care: a qualitative study among health care professionals in the Netherlands. BMC Fam Pract. 2013;14: 114.
Elliott DJ, Robinson EJ, Sanford M, Herman JW, Riesenberg LA. Systemic barriers to diabetes management in primary care: A qualitative analysis of Delaware physicians. Am J Med Qual. 2011;26(4):284–290.
O’Connor R, Mannix M, Mullen J, Powys L, Mannion M, Nolan HA, Kearney E, Cullen W, Griffin M, Saunders J. Structured care of diabetes in general practice: A qualitative study of the barriers and facilitators. Ir Med J. 2013;106(3):77–80.
McHugh S, O’Mullane M, Perry IJ, Bradley C. Barriers to, and facilitators in, introducing integrated diabetes care in Ireland: a qualitative study of views in general practice. BMJ Open. 2013;3(8): e003217.
Tan AM, Muthusamy L, Ng CC, Phoon KY, Ow JH, Tan NC. Initiation of insulin for type 2 diabetes mellitus patients: What are the issues? A qualitative study. Singapore Med J. 2011;52(11):801–809.
Furler J, Spitzer O, Young D, Best J. Insulin in general practice: Barriers and enablers for timely initiation. Aust Fam Physician. 2011;40(8):617–621.
Nam S, Chesla C, Stotts NA, Kroon L, Janson SL. Barriers to diabetes management: patient and provider factors. Diabetes Res Clin Pract. 2011; 93(1):1–9. [PubMed]
Vencio S, Paldanius PM, Bluher M, Giannella-Neto D, Caiado-Vencio R, Strain WD. Understanding the barriers and improving care in type 2 diabetes mellitus: Brazilian perspective in time to do more in diabetes. Diabetol Metab Syndr. 2017;9: 46.
Yuncken J. Barriers to implementing change within diabetes care. Wound Practice & Research: Journal of Australian Wound Management Association. 2014; 22(1).