Barriers to good glycaemic control: the patient's perspective.

Diabetes currently affects at least 120 million people worldwide, and this figure is rising steadily. Intensive treatment improves outcome in terms of morbidity from late diabetic complications and quality of life, but in order for patients to reap such benefits, they must commit to major, long-term changes in lifestyle. The physician's concept of diabetes is often very different from the patient's; and the implementation of a treatment plan acceptable to both is only possible when open communication fosters discussion and patient autonomy, and treatment is seen as logical, acceptable and feasible within the daily life of each patient. Barriers that impair patients' ability to achieve good glycaemic control include those relating to lifestyle, education, psychology and their environment. An appreciation of barriers to good glycaemic control from the patient's perspective underlies the ability to minimise obstacles and improve outcome in terms of quality of life and metabolic control.