Barriers to control of blood glucose in diabetes mellitus

The purpose of this study was to characterize the barriers to tight control of diabetes mellitus. The study collected data from multiple sources at a primary health care clinic in an academic teaching hospital serving an urba n population, including patients' charts, structured interviews with patien ts, a survey of physicians' general perspectives and beliefs concerning dia betes mellitus, and a physician's structured review of barriers to tight co ntrol for individual patients. One hundred thirty five patients with schedu led appointments were eligible for the study, of whom 94% had had a recent hemoglobin A(1)C (HbA(1)C). Seventy seven of 88 patients (88%) who presente d for their appointments consented to the interview, 48 of 50 providers (96 %) returned useable surveys, and providers completed individual assessments for 96 patients (71%). Patients had a mean age of 61 years, an average of 7.60 diagnoses, and an average of 8.96 prescriptions. Their diabetes contro l was less than ideal, with less than 15% having normal or near normal cont rol and almost a quarter having poor control. Correlations of HbA(1)C with age and show rate were seen. Physicians' assessments showed that motivation and understanding of diabetes and compliance with diet and medications cor related with diabetes control. Neither patient knowledge nor physician know ledge appeared to be a problem, nor did either correlate with diabetes cont rol. The number of barriers to control were many, with over half of the pat ients having five or more barriers. Tight control of blood glucose is felt to be an important aspect of quality care for diabetic patients. In this st udy, a representative sample of diabetic patients had less than ideal diabe tes control. This population was receiving their care in an urban setting a nd had many comorbid illnesses and many barriers to control. Age, motivatio n, understanding of the disease, show rate, and compliance with diet and me dications had statistical correlations with diabetes control. In order to i mprove the quality of care for diabetic patients, barriers to care must be addressed.