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 .
Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study
Summary In primary care it is difficult to treat the growing number of non-insulin-dependent diabetic ( NIDDM ) patients according to (inter)national guidelines . A prospect i ve , controlled cohort study was design ed to assess the intermediate term ( 2 years ) effect of structured NIDDM care in general practice with and without ‘ diabetes service ’ support on glycaemic control , cardiovascular risk factors , general well-being and treatment satisfaction . The ‘ diabetes service ’ , supervised by a diabetologist , included a patient registration system , consultation facilities of a dietitian and diabetes nurse educator , and protocol ized blood glucose lowering therapy advice which included home blood glucose monitoring and insulin therapy . In the study group ( SG ; 22 general practice s ) , 350 known NIDDM patients over 40 years of age ( 206 women ; mean age 65.3 ± SD 11.9 ; diabetes duration 5.9 ± 5.4 years ) were followed for 2 years . The control group ( CG ; 6 general practice s ) consisted of 68 patients ( 28 women ; age 64.6 ± 10.3 ; diabetes duration 6.3 ± 6.4 years ) . Mean HbAlc ( reference 4.3 - 6.1 % ) fell from 7.4 to 7.0 % in SG and rose from 7.4 to 7.6 % in CG during follow-up ( p = 0.004 ) . The percentage of patients with poor control ( HbA1c>8.5 % ) shifted from 21.4 to 11.7 % in SG , but from 23.5 to 27.9 % in CG ( p = 0.008 ) . Good control ( HbAlc > 7.0 % ) was achieved in 54.3 % ( SG ; at entry 43.4 % ) and 44.1 % ( CG ; at entry 54.4 % ) ( p = 0.013  ) . Insulin therapy was started in 29.7 % ( SG ) and 8.8 % ( CG ) of the patients ( p = 0.000 ) with low risk of severe hypoglycaemia ( 0.019/patient year ) . Mean levels of total and HDL-cholesterol ( SG ) , triglycerides ( SG ) and diastolic blood pressure ( SG + CG ) and the percentage of smokers ( SG ) declined significantly , but the prevalence of these risk factors remained high . General well-being ( SG ) did not change during intensified therapy . Treatment satisfaction ( SG ) tended to improve . Implementation of structured care , including education and therapeutic advice , results in sustained good glycaemic control in the majority of NIDDM patients in primary care , with low risk of hypoglycaemia . Lowering cardiovascular risk requires more than reporting results and referral to guidelines . [ Diabetologia ( 1997 ) 40 : 1334 -
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 .