What are the common factors affecting poor diabetic control?

Common Factors Affecting Poor Diabetic Control

Multiple factors contribute to poor diabetic control, including patient-related, treatment-related, and healthcare system-related factors, with medication non-adherence, lack of diabetes education, and psychosocial issues being the most significant contributors.

Patient-Related Factors

• Medication non-adherence: Between 36-93% of patients with type 2 diabetes exhibit inadequate adherence to oral antidiabetic agents (defined as collecting <80% of prescribed medication), significantly contributing to poor glycemic control 1.

• Forgetfulness: About 21.8% of patients attribute their medication non-adherence to simply forgetting to take their medications 2.

• Duration of diabetes: Patients with diabetes duration ≤5 years (82.07%) show better medication compliance compared to those with >5 years duration (60.8%) 2.

• Psychosocial issues:

  • Depression and anxiety are 2-3 times more common in patients with diabetes 3.
  • Emotional and behavioral disorders significantly impact diabetes management 3.
  • Family stress is associated with higher HbA1c levels 3.

• Poor dietary adherence: Only 54.3% of patients report good adherence to dietary regimens, and only 1% of youth with type 2 diabetes meet the ADA recommendation for <7% intake of saturated fat 4, 5.

• Inadequate physical activity: Only 31.7% of patients report good adherence to physical exercise regimens 4.

  • Youth with both type 1 and type 2 diabetes appear to be more sedentary and less fit than non-diabetic youth 5.

• Health literacy and numeracy limitations: Patients with diabetes often need to perform numeric tasks such as interpreting food labels and blood glucose levels to make treatment decisions, making health literacy and numeracy essential for effective self-management 5.

Treatment-Related Factors

• Complex medication regimens: Multiple daily dosing and complex regimens contribute to poor adherence 1.

• Medication side effects: Concerns about medication side effects are frequently reported as barriers to adherence 6.

• Hypoglycemia risk: Fear of hypoglycemia can lead to deliberate non-adherence to avoid low blood sugar episodes, particularly in patients on insulin or sulfonylureas 5.

• Polypharmacy: Multiple medications for diabetes and comorbid conditions increase the risk of non-adherence 1.

Healthcare System and Social Factors

• Inadequate diabetes education: Lack of knowledge about diabetes and the importance of controlling it significantly impacts adherence 6.

• Limited social support: Only 46.5% of patients report receiving good social support for diabetes from their family 4.

• Socioeconomic barriers:

  • Lack of adequate health insurance 5.
  • Financial limitations affecting medication access 1.
  • Food insecurity affecting dietary adherence 5.

• Healthcare access issues:

  • Complex childcare arrangements limiting appointment attendance 5.
  • Limited access to healthcare providers, particularly in rural areas 5.

• Cultural and religious factors: Health/cultural/religious beliefs that conflict with current diabetes treatment plans 5.

Special Population Considerations

Older Adults

• Comorbidities: The presence of multiple chronic illnesses increases the risk of poor diabetes control 5.

• Cognitive impairment: Increases risk of medication errors and hypoglycemia 5.

• Functional limitations: May impair ability to perform self-care activities 5.

Children and Adolescents

• Family dynamics: Single-parent homes, chronic physical or mental health problems in family members, and recent major life changes (e.g., job loss, death in family) increase risk for poor control 5.

• Developmental challenges: Adolescents face unique challenges with diabetes management due to desire for independence, peer pressure, and desire to "fit in" 3.

• School-related issues: Poor school attendance and learning disabilities predict difficulties with diabetes management 3.

Impact of Poor Control

• Increased risk of complications: Poorly controlled diabetes of several years' duration is more likely to involve complications 7.

• Reduced quality of life: Both poor control and the presence of complications contribute to increased disability and reduced quality of life 7.

Strategies to Improve Control

• Individualized glycemic targets: Set appropriate HbA1c target ranges based on patient characteristics, comorbidities, and life expectancy 5.

• Enhanced diabetes education: Increased dietary education and counseling with emphasis on importance and benefits of compliance may improve control 7.

• Simplified medication regimens: Consider medication options that reduce pill burden and dosing frequency 1.

• Addressing psychosocial issues: Screen for and address depression, anxiety, and diabetes-related distress 3.

• Family involvement: Teaching family members effective problem-solving and conflict-resolution skills can improve diabetes management 3.

• Community health workers: Can be part of a cost-effective strategy to improve diabetes management, particularly in underserved communities 5.

• Telemedicine: Has growing evidence for effectiveness in rural populations or those with limited physical access to healthcare 5.

Common Pitfalls in Managing Poor Control

• Focusing only on medication adjustments without addressing underlying adherence issues 5.

• Overlooking psychosocial factors that may be driving non-adherence 3.

• Setting overly aggressive targets in patients at high risk for hypoglycemia 8.

• Failing to consider health literacy and numeracy when providing diabetes education 5.

• Not recognizing the impact of social determinants of health on diabetes management 5.