Barriers and facilitators to successful management of type 2 diabetes mellitus in Latin America and the Caribbean: A systematic review

• Published in: PloS one Vol. 15; no. 9; p. e0237542
• Main Authors: Blasco-Blasco, Mar, Puig-García, Marta, Piay, Nora, Lumbreras, Blanca, Hernández-Aguado, Ildefonso, Parker, Lucy Anne
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 04-09-2020; Public Library of Science (PLoS)
• Subjects: Biology and Life Sciences; Care and treatment; Caregivers; Caribbean Region - epidemiology; Complications; Context; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - prevention & control; Diabetes Mellitus, Type 2 - therapy; Diabetic retinopathy; Disease control; Disease Management; Disease prevention; Ethnicity; Evaluation; Health care; Health care access; Health care disparities; Health care policy; Health care services accessibility; Health promotion; Health Services Accessibility; High income; Humans; Latin America - epidemiology; Living conditions; Medicine and Health Sciences; Patient-Centered Care; Patients; Professional practice; Public health; Public policy; Research and Analysis Methods; Risk analysis; Risk Factors; Risk management; Socioeconomic factors; Systematic review; Type 2 diabetes; Caribbean Region; Latin America; Caribbean Islands; Caribbean area; Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0237542

Given that most evidence-based recommendations for managing type 2 diabetes mellitus (T2DM) are generated in high-income settings, significant challenges for their implementation exist in Latin America and the Caribbean region (LAC), where the rates of T2DM and related mortality are increasing. The aim of this study is to identify the facilitators and barriers to successful management of T2DM in LAC, from the perspectives of patients, their families or caregivers, healthcare professionals, and/or other stakeholders.
We conducted a systematic review in MEDLINE, Web of Science, SciELO, and LILACS. We included studies of disease management, prevention of complications and risk factor management. We qualitatively synthesized the verbatim text referring to barriers and/or facilitators of diabetes management according to the Theoretical Domain Framework and described their relative frequencies.
We included 60 studies from 1,595 records identified. 54 studies (90%) identified factors related to the environmental context and resources, highlighting the importance of questions related to health care access or lack of resources in the health system, and the environmental context and living conditions of the patients. Issues related to "social influences" (40 studies) and "social/professional role and identity" (37 studies) were also frequently addressed, indicating the negative impact of lack of support from family and friends and clinicians' paternalistic attitude. 25 studies identified patients beliefs as important barriers, identifying issues such as a lack of patients' trust in the effectiveness of the medication and/or the doctor's advice, or preferences for alternative therapies.
Successful diabetes management in LAC is highly dependent on factors that are beyond the control of the individual patients. Successful disease control will require emphasis on public policies to reinforce health care access and resources, the promotion of a patient-centred care approach, and health promoting infrastructures at environmental level.