Barriers to the delivery of diabetes care in the Middle East and South Africa: a survey of 1,082 practising physicians in five countries

Abstract

Aims: Developing countries face a high and growing burden of type 2 diabetes. We surveyed physicians in a diverse range of countries in the Middle East and Africa (Egypt, Kingdom of Saudi Arabia, United Arab Emirates, South Africa and Lebanon) with regard to their perceptions of barriers to type 2 diabetes care identified as potentially important in the literature and by the authors. Methods: One thousand and eighty-two physicians completed a questionnaire developed by the authors. Results: Most physicians enroled in the study employed guideline-driven care; 80-100% of physicians prescribed metformin (with lifestyle intervention, where there are no contraindications) for newly diagnosed type 2 diabetes, with lifestyle intervention alone used where metformin was not prescribed. Sulfonylureas were prescribed widely, consistent with the poor economic status of many patients. About one quarter of physicians were not undertaking any form of continuing medical education, and relatively low proportions of practices had their own diabetes educators, dieticians or diabetic foot specialists. Physicians identified the deficiencies of their patients (unhealthy lifestyles, lack of education and poor diet) as the most important barriers to optimal diabetes care. Low-treatment compliance was not ranked highly. Access to physicians did not appear to be a problem, as most patients were seen multiple times per year. Conclusions: Physicians in the Middle East and South Africa identified limitations relating to their patients as the main barrier to delivering care for diabetes, without giving high priority to issues relating to processes of care delivery. Further study would be needed to ascertain whether these findings reflect an unduly physician-centred view of their practice. More effective provision of services relating to the prevention of complications and improved lifestyles may be needed. What's knownIt is known that the success of care for diabetes depends critically on the delivery of optimised care for diabetic patients. Many barriers to the delivery of such care have been identified. Relatively little is known regarding how these barriers influence the delivery of diabetes care in the Middle East and South Africa. What's newPhysicians generally followed management guidelines in type 2 diabetes care. Perceived barriers to optimal diabetes care mainly focussed on attributes of patients, rather than process issues in care or aspects of the physicians' practice.

<p>Effectiveness of Diabetes Self-Management Educational Programs For Type 2 Diabetes Mellitus Patients In Middle East Countries: A Systematic Review</p>

“…10 Unfortunately, there are many barriers to optimal diabetes care for patients in ME countries including patients' lifestyles and lack of patient education. 11 DM self-management education (DSME) and support is a crucial part of establishing and implementing the principles of diabetes care. 10 Many reviews were conducted to evaluate the benefits of DSME programs for T2DM patients in developed 12,13 and developing countries; 14 however, only one review study was conducted specifically to assess the benefits of such programs for patients living in ME countries and was focusing on T1DM patients 15 while no review study was conducted on T2DM patients.…”

Stakeholders’ perceptions of dietary and related self-management challenges and education programme preferences for type 2 diabetes adults

“…8 Despite the important role of DSME, poor diabetes knowledge among people with diabetes is a significant barrier to effective self-management. [9][10][11][12] In developing countries, several calls have been made to intensify DSME to improve self-care among people with diabetes. 13,14 However, in developing countries structured DSME programmes are few.…”

Diabetes care among urban women in Soweto, South Africa: a qualitative study

“…Although community health worker programs seem to be effective at improving control of diabetes, systemic factors like too few doctor visits and insufficient patient monitoring by clinic staff hinder programs’ activities [ 22 ]. Moreover, doctors express lifestyle changes as the major obstacles to diabetes care [ 23 ], placing blame on the patients as opposed to the system. This contrasts to qualitative studies with women living with diabetes who mistrust the healthcare system and find it unreliable [ 17 ].…”