Diabetes poses numerous challenges in clinical practice. Some of the most commonly encountered include:
- High treatment costs. Diabetes is a progressive disease that requires ongoing intervention and, often, treatment intensification utilizing combination therapy with 2 or more medications as the disease progresses. For some patients, the costs of increasing insurance premiums, deductibles, copays, and coinsurance are prohibitive.1
- Patient adherence. Cost of treatment, access to care, health literacy, and competing priorities are frequently cited by patients and providers as barriers to effective diabetes treatment and management.1 Comorbidies such as depression and stress have also been shown to negatively impact patient adherence and diminish glycemic control.2
- Lack of disease intervention for prediabetes. According to the Centers for Disease Control and Prevention, 1 in 3 adults currently has prediabetes, and only 7% to 10% of them are aware of it. Without intervention, as many as 30% of people with prediabetes will develop type 2 diabetes within 3 years, placing a tremendous burden on individuals, society, and the healthcare system.1
- Poor coordination among healthcare providers. Electronic health information often is not easily retrievable, making it difficult for providers to identify patients with diabetes and track their multidisciplinary care.3
- Delayed intensification of therapy. Treatment failure can lead to persistent hyperglycemia, disease progression, and microvascular and macrovascular complications. Conversely, early, aggressive therapy intensification has been shown to be efficacious for glycemic control and may lead to improved patient adherence. 4,5
- Difficulty achieving glycemic targets. Lack of education, polypharmacy, and duration of diabetes ≥7 years have been shown to be significantly associated with poorer glycemic control.2
Referral to appropriate resources for diabetes education, financial assistance, intensive behavioral counseling, and emotional support, as well as the use of combination therapy to treat diabetes and comorbidities whenever possible, can aid clinicians and their patients with diabetes in overcoming many of these commonly encountered challenges, leading to more positive outcomes. In all cases, it is essential to engage the patient as a key stakeholder in his or her own care through shared decision-making and patient-centered, nonjudgmental communication.
- Appold K. Four biggest challenges in diabetes health management. http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/four-biggest-challenges-diabetes-health-management?page=0 Accessed March 14, 2017.
- Badedi M, Solan Y, Darraj H, et al. Factors associated with long-term control of type 2 diabetes mellitus. J Diabetes Res. 2016;2016:2109542.
- Appiah B, Hong Y, Ory MG, et al. Challenges and opportunities for implementing diabetes self-management guidelines. J Am Board Fam Med. 2013;26:90-92.
- Zonszein J, Groop PH. Strategies for diabetes management: using newer oral combination therapies early in the disease. Diabetes Ther. 2016;7:621-639.
- Bianchi C, Daniele G, Dardano A, Miccoli R, Del Prato S. Early combination therapy with oral glucose-lowering agents in type 2 diabetes. Drugs. 2017;77:247-264.