Through this review , we found two key health system barriers to effective T2DM care and management : financial constraints faced by the patient and limited access to health services and medication .
This review points to the importance of reducing , or possibly eliminating , out-of-pocket costs for diabetes medication and self-monitoring supplies .
BACKGROUND Type 2 Diabetes Mellitus ( T2DM ) is reported to affect one in 11 adults worldwide , with over 80 % of T2DM patients residing in low-to-middle-income countries .
Health systems play an integral role in responding to this increasing global prevalence , and are key to ensuring effective diabetes management .
We conducted a systematic review to examine the health system-level factors influencing T2DM awareness , treatment , adherence , and control .
A Randomized Controlled Trial to Provide Adherence Information and Motivational Interviewing to Improve Diabetes and Lipid Control
Purpose The purpose of this study was to assess whether providing medication adherence information with or without motivational interviewing improves diabetes and lipid control . Methods Study participants were adult members of a health system in southeast Michigan , were using both oral diabetes and lipid-lowering medications , and had glycated hemoglobin ( A1C ) or low-density lipoprotein cholesterol ( LDL-C ) levels not at goal . Participants were r and omly assigned to receive usual care ( UC ) , n = 567 ; have medication adherence information ( AI ) provided to their physician , n = 569 ; or have AI and receive motivational interviewing ( MI ) though trained staff ( AI + MI ) , n = 556 . Primary outcomes were A1C and LDL-C levels at 18 months post r and omization . Results Primary outcomes were not significantly different between patients in the AI or AI + MI study arms when compared with UC . Similarly , neither oral diabetes nor lipid-lowering medication adherence was significantly different between groups . Patient participation in the AI + MI arm was low and limit the interpretation of the study results , but post hoc analysis of the AI + MI study arm showed that the number of MI  sessions received was positively associated with only oral diabetes medication adherence . Conclusion Neither AI nor MI significantly improved diabetes and lipid control when compared with UC . Moreover , patient participation appeared to be a particular barrier for MI
Through this review , we found two key health system barriers to effective T2DM care and management : financial constraints faced by the patient and limited access to health services and medication .
This review points to the importance of reducing , or possibly eliminating , out-of-pocket costs for diabetes medication and self-monitoring supplies .
BACKGROUND Type 2 Diabetes Mellitus ( T2DM ) is reported to affect one in 11 adults worldwide , with over 80 % of T2DM patients residing in low-to-middle-income countries .
Health systems play an integral role in responding to this increasing global prevalence , and are key to ensuring effective diabetes management .
We conducted a systematic review to examine the health system-level factors influencing T2DM awareness , treatment , adherence , and control .