Photo Credit: Saifulasmee Chede
Researchers identified six themes, such as awareness of disease and fear of adverse outcomes, as helping or hindering patients in T2D management and coping.
A recent meta-synthesis published in Current Diabetes Reviews identified six psychosocial barriers to, and facilitators of, disease management among people with T2D.
The study’s authors noted that while diabetes is a metabolic disease, its management and treatment can be influenced by various social and psychological factors in patients’ lives.
“A reciprocal connection between diabetes and psychosocial factors exists in which various factors determine the management of diabetes, while poorly managed diabetes has adverse psychosocial outcomes,” wrote P. Padma Sri Lekha and E.P. Abdul Azeez, affiliated with the Vellore Institute of Technology in India. “The literature on psychosocial aspects of diabetes management is minuscule and scattered. This synthesis sought to understand the psychosocial facilitators and barriers to T2D management and coping among adults from the available literature.”
Identifying Psychosocial Factors
The researchers evaluated 24 articles about adults with T2D. Studies were excluded if they focused on patients older than 60, included patients with type 1 diabetes, were published in a language other than English, or included patients with comorbid psychiatric conditions.
The articles were published from 2010 to 2023. This period was useful for the analysis because it captured when the World Health Organization reported a global surge in T2D.
Lekha and Azeez identified six themes in their meta-synthesis that acted as either facilitators or barriers to managing diabetes:
- Patient awareness of health and disease;
- Cognitive-emotional factors;
- Constraints to behavioral change;
- Faith;
- Relationship between patient and health care provider; and
- Social constraints and support.
Azeez and Lekha noted two sub-themes of cognitive-emotional factors, namely emotions and self-prioritization. Positive emotions, like confidence in health care services, help facilitate diabetes management, as does a fear of complications. Negative emotions, conversely, may hinder disease management, such as when troubling thoughts lead to emotional eating and possibly higher blood glucose levels. Fear of poorly managed disease and AEs related to unmanaged T2D also helped motivate patients to take better care of themselves.
Putting Findings Into Practice
Carrie M. Burns, MD, who was not involved in the study, said the findings could help clinicians find ways to address barriers to effective diabetes management.
“A little bit of fear is a good thing—not a lot of fear,” Dr. Burns explains, noting that she has observed this in her patients. “We can increase the roles of what we find to be facilitators and decrease the constraints on optimal care.”
Dr. Burns adds that although a negative emotion might seem like a barrier to disease management, being concerned about what might happen if their condition is not properly controlled can motivate patients to do more to control their diabetes. This motivator is linked with other facilitators, such as awareness and education of the disease, faith in health care providers, and a strong clinician-patient relationship.
For instance, if a patient knows they might develop cardiovascular disease, kidney problems, or even lose a leg, they may be more motivated to self-manage their disease, whereas if they do not know these things or do not trust their care team, they may not have the incentive to take care of themselves.
Dr. Burns adds that the analysis reflected many phenomena she saw in the clinic.
“I see this every day. Financial problems, a lack of information, poor relationships between patients and clinicians, and social expectations. These are all difficult,” Dr. Burns says.
She explains that even patients at Penn Medicine, a well-funded health system, live with barriers to proper T2D management. Many of the institution’s West Philadelphia patients live in poverty or food deserts or cope with environmental factors like crime.
“Diabetes is a chronic condition, and any chronic condition takes a toll on the psyche. T2D is hard [to manage] even when things are good. Then, add or remove things like education levels, finances, a stable living environment, or some supermarkets.”
These difficulties, she says, are what make the clinician-patient relationship so important.
“It’s rewarding to have that patient finally get there and figure out what works. You must have a relationship where you care and want them to do well but do not scare them off. It’s that balance of being kind yet firm and still informative,” Dr. Burns says.
