Lack of education. Many patients say they need more DM education, guidance, and support. 6 They report that HCPs tell them how to control DM to avoid complications but say they need more education on how DM affects their lives and concrete suggestions on how to change their lifestyles. Researchers say patients need to feel empowered so they can take a leadership role in managing medications, diet, exercise, preventive foot and eye care, and stress. 7 In contrast, an empowerment approach identifies patients’ inherent capacity to self-direct and motivate themselves to develop a self-managed plan based on their personal goals and priorities. 8 Patients want to be part of the solution.
Communication and language. A significant challenge for elderly patients is loss of hearing and/or vision, which results in difficulty communicating with their HCP. 9 The loss of hearing or vision decreases the ability to adequately collaborate with HCPs and hampers an older adult’s ability to take the lead on self-management. As the U.S. population becomes more diverse, language also poses a significant barrier to care. A language barrier inherently affects health literacy about the disease as well as patients’ perceived trust in HCPs to manage their disease. 3
Medication regimen. There are numerous barriers to taking medications. Polypharmacy is a common cause of more drug interactions and adverse effects, which are the most common reason for stopping medications. 3,10 Cost of medications and difficulty keeping track of multiple medications are also a deterrent to self-management and adherence. Polypharmacy is seen as detrimental to quality of life (QOL). 3 Some patients are also resistant to the initiation and titration of insulin. 11
Lack of resources. Many patients cite a lack of resources to facilitate DM care. Common barriers include delays in being scheduled for medical appointments, lack of transportation to appointments, difficulty paying out-of-pocket copays, high cost of medications, and cost of DM supplies (eg, glucometers, test strips, insulin pens and/or pumps). The lack of access to community green spaces or gyms to increase physical activity is also a common barrier. 12
Health Care Provider Experiences
Lack of motivation. Health care providers’ experiences and motivations can also present barriers to care. Some HCPs believe that evidence-based guidelines are simply theoretical frameworks; they disagree with using these guidelines as a basis to initiate statin therapy or antiglycemic medications, which reduce cardiovascular complications. 13 Many also feel justified in taking a more lax approach when treating older adults due to a lack of time. 13
Lack of education about DM management. Health care providers often feel less prepared to provide DM care and believe additional education in DM care is needed. Many lack formal postgraduate DM education or professional development, and 19.6% have no postgraduate DM education or training. 14 Some are uncomfortable managing insulin because of a lack of knowledge of insulin therapy and its effect on cardiovascular risk. This results in patients remaining too long on oral DM medications and delaying the necessary initiation of insulin. 13
Lack of resources . Some HCPs do not have qualified staff, such as dieticians and diabetes nurse educators, to support DM care. Fearing a loss of control over individual patient care, some HCPs also find it difficult to collaborate with multidisciplinary diabetes care team members, such as psychologists and diabetes educators. 13 A lack of awareness of community programs hampers HCPs’ ability to get patients connected to resources that help them make lifestyle changes. 14