Breaking down patient and physician barriers to optimize glycemic control in type 2 diabetes

Am J Med. 2013 Sep;126(9 Suppl 1):S38-48. doi: 10.1016/j.amjmed.2013.06.012.


Approximately half of patients with type 2 diabetes (T2D) do not achieve globally recognized blood glucose targets, despite the availability of a wide range of effective glucose-lowering therapies. Failure to maintain good glycemic control increases the risk of diabetes-related complications and long-term health care costs. Patients must be brought under glycemic control to improve treatment outcomes, but existing barriers to optimizing glycemic control must first be overcome, including patient nonadherence to treatment, the failure of physicians to intensify therapy in a timely manner, and inadequacies in the health care system itself. The reasons for such barriers include treatment side effects, complex treatment regimens, needle anxiety, poor patient education, and the absence of an adequate patient care plan; however, newer therapies and devices, combined with comprehensive care plans involving adequate patient education, can help to minimize barriers and improve treatment outcomes.

Keywords: Clinical inertia; Glycemic control; Nonadherence.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Blood Glucose / analysis
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diarrhea / chemically induced
  • Diarrhea / prevention & control
  • Fear
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemia / prevention & control
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use*
  • Injections / psychology
  • Medication Adherence*
  • Nausea / chemically induced
  • Nausea / prevention & control
  • Patient Care Planning
  • Patient Education as Topic
  • Physician-Patient Relations*
  • Practice Patterns, Physicians'
  • Weight Gain / drug effects


  • Blood Glucose
  • Hypoglycemic Agents