Review Barriers to diabetes management: Patient and provider factors Soohyun Nam a, *, Catherine Chesla b , Nancy A. Stotts c , Lisa Kroon d , Susan L. Janson e a Johns Hopkins University, School of Nursing, Department of Health Systems and Outcomes, 525 North Wolfe Street, Baltimore, MD 21205-2110, United States b University of California, San Francisco, School of Nursing, Department of Family Health Care Nursing, San Francisco, CA, United States c University of California, San Francisco, School of Nursing, Department of Physiological Nursing, San Francisco, CA, United States d University of California, San Francisco, School of Pharmacy, Department of Clinical Pharmacy, San Francisco, CA, United States e University of California, San Francisco, School of Nursing, Department of Community Health Systems, San Francisco, CA, United States Contents 1. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2. Results of review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2.1. Patient factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2.2. Health care provider factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 3. Discussion and conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 9 3 ( 2 0 1 1 ) 1 – 9 a r t i c l e i n f o Article history: Received 11 June 2010 Received in revised form 8 January 2011 Accepted 3 February 2011 Published on line 5 March 2011 Keywords: Type 2 diabetes Barriers to diabetes management Self-management a b s t r a c t Despite significant advances in diagnosis and treatment, the persistence of inadequate meta- bolic control continues. Poor glycemic control may be reflected by both the failure of diabetes self-management by patients as well as inadequate intervention strategies by clinicians. The purpose of this systematic review is to summarize existing knowledge regarding various barriers of diabetes management from the perspectives of both patients and clinicians. A search of PubMed, CINAHL, ERIC, and PsycINFO identified 1454 articles in English published between 1990 and 2009, addressing type 2 diabetes, patient’s barriers, clinician’s barriers, and self-management. Patients’ adherence, attitude, beliefs, and knowledge about diabetes may affect diabetes self-management. Culture and language capabilities influence the patient’s health beliefs, attitudes, health literacy, thereby affecting diabetes self-management. Other influential factors include the patient’s financial resources, co-morbidities, and social support. Clinician’s attitude, beliefs and knowledge about diabetes also influence diabetes manage- ment. Clinicians may further influence the patient’s perception through effective communi- cation skills and by having a well-integrated health care system. Identifying barriers to diabetes management is necessary to improve the quality of diabetes care, including the improvement of metabolic control, and diabetes self-management. Further research that considers these barriers is necessary for developing interventions for individuals with type 2 diabetes. # 2011 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +1 410 203 1111; fax: +1 410 203 2685. E-mail addresses: soohnam@gmail.com (S. Nam), kit.chesla@nursing.ucsf.edu (C. Chesla), nancy.stotts@nursing.ucsf.edu (N.A. Stotts), KroonL@pharmacy.ucsf.edu (L. Kroon), susan.janson@nursing.ucsf.edu (S.L. Janson). C o n t e n t s l i s t s a v a i l a b l e a t S c i e n c e D i r e c t Diabetes Research and Clinical Practice journal homepage: www.elsevier.com/locate/diabres 0168-8227/$ – see front matter # 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.diabres.2011.02.002