Barriers and facilitators to diabetes self-management in a primary care setting - Patient perspectives

Background: Diabetes self-management (DSM) is a key element in the overall management of type-2 diabetes (T2DM). Identifying barriers and facilitators to DSM and addressing them is a critical step in achieving improved health outcomes in this population. Objective: To assess patient reported barriers and facilitators to self-management of T2DM in a primary care setting. Methods: This cross sectional study combined patient survey data with electronic medical record (EMR) data. Patients (age >= 18 years) with a recorded diagnosis of T2DM (ICD-9 code: 250. xx) and having >= 2 physician visits were identified from a physician group's EMR database. Patients were grouped based on their A1C levels:< 7, 7-9, and > 9. Information on demographics, knowledge of diabetes, attitudes, health beliefs, and level of self-management was collected through survey administration. Survey responses were linked to the EMR data, and additional patient information was extracted. Results: A total of 2100 surveys were administered (700 in each A1C category) of which 210 responses were received (10% response rate). Mean age was 63.7 years (+/- 11.79), 108 (51.4%) were males, and 197 (93.8%) were Caucasian. Age (X-2 = 15.73, p < 0.01), insurance status (X-2 = 12.03, p < 0.05), referral to an endocrinologist (X-2 = 6.17, p < 0.05), level of self-management (X-2 = 12.01, p < 0.05) and willingness to use insulin (X-2 = 9.8, p < 0.01) were associated with glycemic variability. Level of self-management (X-2 = 33.04, p < 0.01) and referral to an endocrinologist (X-2 = 11.11, p < 0.01) were associated with readiness to change DSM behavior. Better self-management, older age, lower willingness to use insulin, and ` less than graduate level' education were significant predictors of glycemic stability. Conclusions: Self-management behavior of patients with T2DM is strongly associated with glycemic stability. Interventions directed towards improving self-management in this population may result in improved clinical outcomes.