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 .
Participative decentralization of diabetes care in Davao City (Philippines) according to the Chronic Care Model: a program evaluation.
AIM To assess the effectiveness of the  Diabetes Project in Davao City , Philippines , regarding diabetes care access , diabetes management and cardiovascular risk factors . The project was developed in accordance with the Chronic Care Model ( CCM ) framework . METHODS A non-r and omized cross-sectional survey was conducted in nine intervention and five control Barangays ( villages ) . People with diabetes aged ≥20 years were interviewed using a structured question naire ; height , weight , waist circumference , and blood pressure were measured ; HbA1c was tested with a NSGP-certified point-of-care device . Logistic regression models were used to compare the two groups . RESULTS The intervention group ( n=503 ) scored better than the controls ( n=136 ) on the following ( OR , 95 % CI ) : percentage of patients taking metformin ( 1.5 , 1.0 - 2.2 ) ; and in the last 12 months : laboratory test for fasting blood sugar ( 1.6 , 1.1 - 2.3 ) , HbA1c ( 6.0 , 2.4 - 15.1 ) , lipid profile ( 1.7 , 1.1 - 2.5 ) , nutritionist visit ( 1.6 , 1.0 - 2.5 ) and therapeutic education session ( 2.7 , 1.8 - 4.0 ) . Glycemic control ( HbA1c<7 % ) was also better in the intervention Barangays ( 1.6 , 1.0 - 2.4 ) . There were no statistical differences between the two groups for number of visits , and levels of other cardiovascular risk factors . CONCLUSIONS Our findings support the effectiveness of implementing the CCM framework in a low-to-middle income country on glycemic control and diabetes management
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 .