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 .
Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial.
AIMS To evaluate patient outcomes for a novel integrated primary /specialist model of community care for complex Type 2 diabetes mellitus management compared with outcomes for usual care at a tertiary hospital for diabetes out patients . METHODS This was a prospect i ve open controlled trial performed in a primary and tertiary care setting in Australia . A total of 330 patients with Type 2 diabetes aged > 18 years were allocated to an intervention ( n=185 ) or usual care group ( n=145 ) . The intervention arm was a community-based model of care led by a general practitioner with advanced skills and an endocrinologist partnership . Usual care was provided via the hospital diabetes outpatient department . The primary end point was HbA(1c ) concentration at 12 months . Secondary end points included serum lipids and blood pressure . RESULTS The mean change in HbA1c concentration in the intervention group was -9 mmol/mol ( -0.8 % ) at 12 months and in the usual care group it was -2 mmol/mol ( -0.2 % ) ( 95 % CI -5,1 ) . The percentage of patients in the intervention group achieving the HbA(1c ) target of ≤53 mmol/mol ( 7 % ) increased from 21 to 42 % ( P<0.001 ) ; for the usual care group there was a 1 % increase to 39 % of patients attaining this target ( P=0.99 ) . Patients in the intervention group experienced significant improvements in blood pressure and total cholesterol compared with those in the usual care group . The percentage of patients achieving clinical targets was greater in the intervention group for the combined target of HbA(1c ) concentration , blood pressure and LDL cholesterol . CONCLUSIONS A community-based , integrated model of complex diabetes care , delivered by general practitioners with advanced skills , produced clinical and process benefits compared with a tertiary diabetes outpatient clinic
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 .