Barriers and facilitators to diabetes service uptake and self-care management in Australia: a scoping review.

backgroundDiabetes represents a major and increasing public health burden in Australia. Despite this, there remains limited consolidated evidence on patterns of diabetes-related service uptake and self-management, particularly among priority population groups. This scoping review synthesizes existing evidence on diabetes-related health service utilization and self-management practices in Australia, focusing on key barriers and facilitators that affect access to care and engagement in self-management.

methodsWe conducted a scoping review of journal articles published up to 20 October 2025. Major databases: PubMed, Embase, Scopus, and Web of Science, were utilized along with manual reference searches. Articles were screened in two stages, and data were extracted using a piloted template. A descriptive thematic analysis was performed focusing on the three major themes: service uptake, self-care management, and the associated barriers and facilitators. Diabetes service uptake was categorized into three subthemes: practitioner-based primary care, allied health and preventive services, and acute and emergency care. Moreover, the barriers and facilitators were organized using the socioecological framework.

resultsThirty-two articles were included in this review. The general population showed consistent engagement with practitioner-based routine diabetic services, with studies reporting up to 92% of adults visiting their general practitioners and having at least one HbA1c test over a six-month period. Aboriginal and Torres Strait Islander people also showed an improvement in primary care engagement despite a historical high dependency in acute care. In contrast, areas containing a higher proportion of overseas-born residents tended to rely more on acute services. The uptake of preventive services and allied health care was inconsistent and generally low. For example, up to 40% of adults had no contact with diabetes educators, dietitians, or podiatrists in some rural populations. One study has also reported that only 55.2% of high-risk adults were screened at least once for diabetes over a three-year period. Key barriers to service uptake and/or self-care management included limited health literacy, fragmented care pathways, financial constraints, cultural and language barriers, geographic remoteness, and variable digital capability. In contrast, coordinated multidisciplinary care, structured management plan, strong patient-provider relationship, social support, and access to digital health services were reported as important facilitators. Telehealth has also emerged as an effective facilitator for maintaining engagement, particularly during the COVID-19 pandemic.

conclusionDespite high engagement with routine primary care, significant gaps remain in preventive services and allied health use among people with diabetes in Australia, particularly among younger adults, rural residents, and socioeconomically disadvantaged or culturally diverse populations. Addressing these gaps requires equitable, person-centered, and integrated multidisciplinary care that aligns with patients' cultural values and everyday lives, alongside efforts in improving health literacy.