Quality of diabetes care: problem of patient or doctor adherence?

Current guidelines for treatment of type 2 diabetes mellitus include disease prevention and the control of blood pressure and lipids in addition to blood glucose management. However, physician compliance with treatment guidelines is relatively poor. In any given year, HbA1c and blood lipids are measured only in about half of patients and are below target in even less, while blood pressure is frequently measured but controlled in less than 50%. Some reasons for this unsatisfactory situation are providers' beliefs, frustration and lack of knowledge, patient barriers and the fact that the guidelines are not easy to access and implement. Patient non-adherence can be changed by improving education, perception, motivation and self-management. Strategies for improving disease management are discussed.