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

Author

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  • Mar Blasco-Blasco
  • Marta Puig-García
  • Nora Piay
  • Blanca Lumbreras
  • Ildefonso Hernández-Aguado
  • Lucy Anne Parker

Abstract

Background: 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. Methods: 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. Findings: 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. Conclusions: 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.

Suggested Citation

  • Mar Blasco-Blasco & Marta Puig-García & Nora Piay & Blanca Lumbreras & Ildefonso Hernández-Aguado & Lucy Anne Parker, 2020. "Barriers and facilitators to successful management of type 2 diabetes mellitus in Latin America and the Caribbean: A systematic review," PLOS ONE, Public Library of Science, vol. 15(9), pages 1-19, September.
  • Handle: RePEc:plo:pone00:0237542
    DOI: 10.1371/journal.pone.0237542
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    References listed on IDEAS

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    1. Mapa Mudiyanselage Prabhath Nishantha Piyasena & Gudlavalleti Venkata S Murthy & Jennifer L Y Yip & Clare Gilbert & Maria Zuurmond & Tunde Peto & Iris Gordon & Suwin Hewage & Sureshkumar Kamalakannan, 2019. "Systematic review on barriers and enablers for access to diabetic retinopathy screening services in different income settings," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-29, April.
    2. Jennifer Manne-Goehler & Pascal Geldsetzer & Kokou Agoudavi & Glennis Andall-Brereton & Krishna K Aryal & Brice Wilfried Bicaba & Pascal Bovet & Garry Brian & Maria Dorobantu & Gladwell Gathecha & Mon, 2019. "Health system performance for people with diabetes in 28 low- and middle-income countries: A cross-sectional study of nationally representative surveys," PLOS Medicine, Public Library of Science, vol. 16(3), pages 1-21, March.
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