Overcoming Barriers to Diabetes Control

Here at Diabetes Flashpoints, we often focus on overcoming certain barriers that people with diabetes face in areas like blood glucose control, exercise, healthy eating, and affordable access to health care. In today’s health-care system in the United States, it’s usually the job of the patient to identify and try to overcome many of these barriers — often with the help of health information resources like DiabetesSelfManagement.com, and sometimes with help from a professional like a dietitian, personal trainer, or Health Insurance Marketplace Navigator. But what if it were health-care providers, rather than patients, who took the leading role in identifying and working to overcome these barriers?

A recent study sought to find out whether assigning a certified diabetes educator (CDE) to help people overcome practical barriers to their diabetes management could help them lower their HbA1c level (a measure of long-term blood glucose control). Published earlier this month in the journal Diabetes Care, the study looked at 155 people with Type 2 diabetes whose blood glucose control was far less than ideal — those with an HbA1c level greater than 9.0%. Each was assigned to a CDE who acted as a “case manager” for 12 months, working to identify barriers to diabetes management and develop strategies to help overcome them on an individual basis.

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As described in a Physician’s Briefing article on the study, the most common barriers to diabetes control that the researchers identified were psychological help and support (affecting 93% of participants), socioeconomic barriers (87%), and limited access to care or treatments (82%). None of these barriers, on its own, could predict that a participant had a higher HbA1c level.

But the results of working to overcome them were dramatic — after 12 months, participants in the CDE program had lowered their HbA1c level by an average of 1.5%. For comparison, a matched group of people with the same characteristics (age, diabetes type, blood glucose control, etc.) at the beginning of the study — but who received standard care, without any barrier-based intervention — lowered their HbA1c level by an average of only 0.5%. There was no change in either group in the incidence of severe hypoglycemia (low blood glucose), which indicates that lower HbA1c was achieved without increasing this risk.

What’s your impression of barrier-based diabetes care — do you think you face any of the types of barriers identified in the study? Do you feel that your health-care provider already works with you to identify these kinds of problems, or are you left to identify and deal with them on your own? Would you be interested in working with a CDE to identify barriers to better diabetes control, if this service were offered at no extra cost? Should health insurers be required to cover counseling to help people with less-than-ideal blood glucose control identify and overcome barriers to their diabetes management? Leave a comment below!