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 .
Management of type 2 diabetes in China: the Happy Life Club, a pragmatic cluster randomised controlled trial using health coaches
Objective To assess the effectiveness of a coach-led motivational interviewing ( MI ) intervention in improving glycaemic control , as well as clinical , psychosocial and self-care outcomes of individuals with type 2 diabetes mellitus ( T2DM ) compared with usual care . Design Pragmatic cluster r and omised controlled trial ( RCT ) . Setting Community Health Stations ( CHSs ) in Fengtai district , Beijing , China . Participants Of the 41 r and omised CHSs ( 21 intervention and 20 control ) , 21 intervention CHSs ( 372 participants ) and 18 control CHSs ( 296 participants ) started participation .  Intervention Intervention participants received telephone and face-to-face MI health coaching in addition to usual care from their CHS . Control participants received usual care only . Medical fees were waived for both groups . Outcome measures Outcomes were assessed at baseline , 6 and 12 months . Primary outcome measure was glycated haemoglobin ( HbA1c ) . Secondary outcomes included a suite of anthropometric , blood pressure ( BP ) , fasting blood , psychosocial and self-care measures . Results At 12 months , no differential treatment effect was found for HbA1c ( adjusted difference 0.02 , 95 % CI −0.40 to 0.44 , p=0.929 ) , with both treatment and control groups showing significant improvements . However , two secondary outcomes : psychological distress ( adjusted difference −2.38 , 95 % CI −4.64 to −0.12 , p=0.039 ) and systolic BP ( adjusted difference −3.57 , 95 % CI −6.08 to −1.05 , p=0.005 ) were robust outcomes consistent with significant differential treatment effects , as supported in sensitivity analyses . Interestingly , in addition to HbA1c , both groups displayed significant improvements in triglycerides , LDL cholesterol and HDL cholesterol . Conclusions In line with the current Chinese primary healthcare reform , this study is the first large-scale cluster RCT to be implemented within real-world CHSs in China , specifically addressing T2DM . Although a differential treatment effect was not observed for HbA1c , numerous outcomes ( including HbA1c ) improved in both groups , supporting the establishment of regular , free clinical health checks for people with T2DM in China . Trial registration number IS RCT N01010526 ; Pre- results
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 .