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 Western Australian metropolitan general practice.
The purpose of this study was : ( 1 ) to record GP opinions , practice s and outcomes for the care of Type 2 Diabetes Mellitus ( DM2 ) , ( 2 ) compare practice facilities and process of care with a criterion of recommended competent care and ( 3 ) determine if there were any differences between vocationally registered and non-vocationally registered GPs . A r and om sample of 204 metropolitan doctors from 124 practice s was selected and an audit performed on 467 of their patient records . GPs pursued good blood sugar control and advocated lifestyle changes before hypoglycaemic drugs . Over 80 % regard uncomplicated DM2 as a condition for general practice management . However , only 15 % conducted an annual diabetes check , 9 % had a diabetic register , 6 % a diabetic recall system and 8 % used a diabetic health care checklist for monitoring their patients . The most commonly recorded processes of medical audit in the previous 12 months were : blood pressure ( 94 % ) , duration of diabetes ( 72 % ) , blood glucose ( 70 % ) , diet ( 66 % ) , body weight ( 56 % ) , HBA1c ( 52 % ) and ophthalmoscopy ( 50 % ) . The least commonly recorded processes of care were body mass index ( 5 % ) , inspection of the feet ( 18 % ) , enquiries about vaginitis or impotence ( 23 % ) . The amount of exercise , alcohol and tobacco was recorded in only 34 % of records . Hypoglycaemic drugs were used appropriately but the most commonly used drugs for treating hypertension in DM2 patients were thiazide diuretics and beta-blockers .  Vocationally registered ( VR ) doctors had better records , higher process of care scores and more were willing to participate in the study than non-vocationally registered ( NVR ) doctors . However , there was no difference in metabolic control between patients from either group . The use of a Diabetic Health Care Checklist would improve diabetes care especially in the search for early complications and in the recording of HBA1c and other metabolic parameters . The drugs commonly used to control hypertension can have adverse effects on glucose and lipid metabolism and should be replaced with glucose and lipid neutral drugs
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 .