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Cited by 680Diabetes Management and EducationDiabetes Management and ResearchDiabetes Treatment and Management

Barriers to diabetes management: patient and provider factors

Nam, Soohyun, Chesla, Catherine, Stotts, Nancy A., Kroon, Lisa, Janson, Susan L.·2011·Diabetes Research and Clinical Practice
DOI 10.1016/j.diabres.2011.02.002
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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.

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  • Personal style, defined as the perceived fit between the intervention and the preferred style of clinical practice, personality, and philosophical opposition to the intervention, was presented exclusively as a barrier.

    “Personal style, defined as the perceived fit between the intervention and the preferred style of clinical practice, such as clinicians’ communication style [78, 79], personality [54] and philosophical opposition to the intervention [69, 76], were presented exclusively as barriers.”

    From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [78]

  • Visiting a health care team can be costly and time-consuming for people with type 2 diabetes, and most people with type 2 diabetes do not see their health professionals enough.

    “Visiting a health care team can be costly and time-consuming for people with type 2 diabetes, with evidence suggesting most people with type 2 diabetes do not see their health professionals enough [3].”

    From Effect of virtual care in type 2 diabetes management – a systematic umbrella review of systematic reviews and meta-analysis (2025) · cites this paper as [3]

  • Suboptimal self-management can result from functional limitations, insufficient diabetes education, forgetting and disrupted routines, or psychosocial barriers such as inadequate social support, misinformation, emotional distress, or poor problem-solving and coping skills.

    “Suboptimal self-management may be due to functional limitations (e.g., blindness, problems with dexterity, low health literacy and numeracy), lack of appropriate diabetes education, forgetting and disruption in routines,”

    From Psychosocial care for people with diabetes: a position statement of the American Diabetes Association (2016) · cites this paper as [30]

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Authors
Nam, S., Chesla, C., Stotts, N. A., Kroon, L., & Janson, S. L.
Affiliations
  • Johns Hopkins University (US)
  • University of California, San Francisco (US)
ORCID
Venue
Diabetes Research and Clinical Practice
Publisher
Elsevier BV
Published
2011-07
Volume
93
Issue
1
Pages
1-9
ISSN
0168-8227 (ISSN-L)
DOI
10.1016/j.diabres.2011.02.002
OpenAlex
W1974561455
Cited by
680
References
75
Citations by year
2026: 18 · 2025: 27 · 2024: 38 · 2023: 57 · 2022: 41 · 2021: 58 · 2020: 61 · 2019: 39 · 2018: 61 · 2017: 54 · 2016: 60 · 2015: 61 · 2014: 37 · 2013: 43 · 2012: 20
FWCI
4.53
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Diabetes Research and Clinical Practice (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • California Endowment and American Association of Colleges of Nursing (AACN)
  • Nurse Faculty Program
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
type 2 diabetes, diabetes self-management, glycemic control, patient adherence, health literacy, health beliefs, language and cultural barriers, financial barriers, comorbidities, social support, clinician-patient communication, integrated care
MeSH terms
Diabetes Mellitus, Type 2, Humans, Patient Compliance, Patient Education as Topic, Self Care, Social Support, Disease Management

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