Barriers and facilitators of providing standard of care diabetes management at primary care level in geriatric population.

Background: Geriatric population is gradually increasing and is expected to grow till 20% by 2050 from the current 8.6%, and so is diabetes prevalence and other comorbidities. To improve diabetes control, better coordination of provider, patient and health system is needed. It has been found that almost half of the diabetes patients do not achieve treatment targets. So, it is essential to assess the perceived barriers as well as facilitators from patients' and physicians' perspectives. The aim of the study was assessment of needs, care, barriers and facilitators to achieve treatment goals for patients and physicians. Materials and Methods: This observational, cross-sectional study was conducted by the Department of Geriatrics among 100 elderly diabetes patients and 50 physicians after obtaining ethical approval. All participants were interviewed based on a predefined, structured questionnaire with multiple options to grade or choose from. Results: Polypharmacy, mobility issues and dementia were the most common geriatric issues. Hypertension (HTN), arthritis and coronary artery disease (CAD) were the commonest comorbidities. Also, 73% reported that they followed dietary advice, but only 22% accepted that they were doing exercise regularly. Moreover, 5% mentioned that they were taking alcohol, and 15% confirmed of smoking. Also, 47% of patients felt that diabetes was well controlled. Remaining 53% patients gave reasons for poor diabetes control; the most common reason was not following a proper diabetic diet plan in 42% of patients and lack of exercise as instructed was reported by 22% as the reason for their poor diabetic control. Nineteen percent of patients accepted of not measuring their blood glucose as instructed. Among urban doctors, the three most common factors were not being consistent with lifestyle interventions, followed by no regular self-monitoring of blood glucose and no regular follow-up. Top three interventions suggested were to engage or encourage the family members of patients to become involved in diabetes care, provide more convenient diabetes brochures or education materials to patients and improve multidisciplinary and multispeciality collaboration in diabetes control. Conclusion: Diabetes in elderly needs proactive health system and coordinated care. Doctor-patient relationship with good communication skills, family support and multidisciplinary care is needed to improve diabetes care. Health education with a focus on diet control, exercise and other lifestyle modifications are essential factors in improving diabetes care.