Barriers to insulin initiation in elderly patients with type 2 diabetes mellitus in Brazil

Barriers and facilitators to successful management of type 2 diabetes mellitus in Latin America and the Caribbean: A systematic review

“…Four themes on how “social influences” affect diabetes management were identified in 40 studies (66.7%) [ 27 – 29 , 31 , 32 , 35 , 37 , 39 – 47 , 49 , 51 – 53 , 57 , 59 – 62 , 64 – 67 , 70 , 73 – 77 , 79 , 81 , 83 – 85 ]: lack of and support from family and friends, social gatherings, stigma and peer support. More than half of the studies described that family and friends’ support is a fundamental piece in the management of the disease.…”

“…Regarding “knowledge” (30 studies) [ 27 , 29 – 31 , 34 , 35 , 38 , 39 , 41 , 43 , 46 , 50 – 52 , 58 , 62 , 65 , 67 , 70 – 73 , 75 , 80 – 86 ], the authors recognised the importance of both patient and professional’s knowledge. Lack of professional knowledge was identified as a factor associated with miscommunication and poor management of the side effects.…”

“…The domain “beliefs about consequences” (25 studies) [ 27 , 29 – 31 , 33 , 37 , 39 , 42 , 52 , 53 , 55 , 57 , 59 , 65 , 67 , 68 , 73 , 74 , 76 , 78 , 80 , 83 – 86 ] included studies showing how a lack of trust in the effectiveness of the medication and/or the doctor’s advice led to a negation of the treatment, which is an important barrier (9 studies), and was linked to the use of non-therapeutic remedies for glucose control was discussed in 11 studies.…”

“…According to the “ emotion ” domain [ 27 – 29 , 31 , 32 , 35 , 37 – 39 , 41 , 43 , 46 , 48 , 53 – 55 , 66 , 67 , 70 , 73 ], patients diagnosed with diabetes can feel depression, stress or shame (24 studies). Nevertheless, for some patients, the fear of death or complications is a strong incentive for treatment adherence.…”

Socioeconomic Status and Access to Healthcare: Interrelated Drivers for Healthy Aging

“…Similarly, more expensive healthcare isn't linked to better outcomes, at least among Medicare recipients in the United States (81). In Brazil, where older adults have access to healthcare through a public health care system and private insurance, patient perceptions affect treatment initiation and glycemic control of Type II diabetes (82). Improving access to healthcare by reducing financial disparities and improving wealth among older adults is a vital first step but should not be seen as the final step in ensuring global healthy aging.…”