Barriers to effective management of type 2 diabetes mellitus in primary healthcare facilities

Abstract

Background: In 2024, type 2 diabetes mellitus (T2DM) – a public health challenge – affected 589 million adults worldwide. In South Africa, the prevalence is estimated at 15%, contributing to approximately 3.4 million deaths. Achieving optimal glycaemic control in patients is challenging, resulting in preventable complications and deaths. Systemic reforms and targeted interventions are urgently required.
Aim: To identify barriers faced by healthcare professionals (HCPs) to effectively manage patients with T2DM.
Setting: A survey was conducted in the Tshwane Metropolitan Municipality, Gauteng province, South Africa.
Methods: The study involved 205 HCPs across 22 clinics and 6 community health centres from May 2022 to June 2022. Data were analysed descriptively. Categorical variables were compared using Fisher’s exact test and a p-value of < 0.05 was considered significant.
Results: Most participants were nurses (84%), < 50 years (65%), female (87%), black people (64.7%), and > 10 years experience (65%) and had academic and in-house training on T2DM (38.5%). Key barriers faced by HCPs in managing patients with T2DM included workload making it difficult monitor patients (53%) and screen for complications (57%), time pressures to deliver quality care (59%) and educate patients (69%), inadequate insulin initiation knowledge (68%) and lack of continuity of care (62%).
Conclusion: Excessive workloads, insufficient staffing, time pressures, insulin inertia, and knowledge gaps – impede the delivery of personalised care, patient education and monitoring.
Contribution: Addressing these challenges will require collaborative care models, workforce optimisation, targeted training, better resource allocation and health technology and can significantly improve patient outcomes and alleviate burden among HCPs.