Top Challenges in Managing Diabetes

Drug Topics JournalDrug Topics September 2019
Volume 163
Issue 9

Cost, education, self-monitoring, and more. 

Amy Carter, MA, RD, CDE

Amy Carter, MA, RD, CDE

Patricia Luceri, DO

Patricia Luceri, DO

Ajaz Banka, MD

Ajaz Banka, MD

diabetes blood finger test

Individuals diagnosed with diabetes have to concern themselves about a variety of issues, like blood sugar level, diet, and a complex medication regiment. 

“A lot is required of a person diagnosed with diabetes in terms of what to do and not to do,” says Amy Carter, MA, RD, CDE, director of Outpatient Nutrition for Eskenazi Health in Indianapolis. “Knowing they will have to manage this chronic disease for the rest of their lives, often without education, support, or financial resources, significantly impacts a person’s self-care ability.”

While there are lifelong challenges, the good news is diabetes is manageable, Carter says. Patients can control their condition by making the right choices.

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Here are some of the leading challenges that endocrinologists and educators see from their daily interactions with diabetes patients. 


“We have so many great medications available in our arsenal to treat diabetes,” says Patricia Luceri, DO, an endocrinologist with Jefferson Health in Marlton, New Jersey. “Unfortunately, they’re expensive. If the patient doesn’t have good insurance to cover the cost of the drug, then that drug is not an option. Even with insurance, there are copays, which could be high.

“Often, patients tell me they’ve had to choose between buying food or medication,” she adds. “Many times, they’re trying to stretch their medications by taking them every other day or taking a partial dose.”


“The actual percentage of people who receive the appropriate education about how to manage their diabetes is fractional-less than 10%,” Carter says. “Full diabetes education encompasses food, medicines, checking blood sugar, risk reduction, and other topics. Without education, it’s very challenging for people to understand what happens if they don’t take the appropriate steps.”


“Patients often don’t have access to the supplies they need to monitor their blood glucose levels,” says Ajaz Banka, MD, an endocrinologist with Beaumont Hospital in Michigan. “Testing supplies are expensive. But if patients don’t know their numbers, they don’t know what’s happening [to their health]. ”

“If patients don’t test their sugar, they can’t manage their diabetes,” Luceri says. “It can be cumbersome to test regularly and test in public. There have been many advances in recent years, so this is becoming less of a challenge. There are continuous glucose monitors available to monitor their sugar in real time without a finger stick. However, not every insurance company covers the monitors.”

Medication Adherence 

“Diabetics are always on multiple medications, not just for their diabetes but also for high blood pressure and high cholesterol,” Luceri says. “It can be tough to remember when you’re taking that many medications, often at different times of the day. There is a class of medications that have a once-weekly injection, which can help with compliance. Some companies have programs that will send reminders to the patient to take their medications.”

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Healthy Lifestyle

“Eating is a basic function and asking a patient not to eat a particular food is difficult,” Banka says. “Patients are asymptomatic. They don’t really care, because they don’t see the complications right away, though they could still happen in the future. Cultural and educational background plays a big role in diabetes management. If we can to get across to patients with education why managing diabetes is important, it will play a big role, long term, in their health.”

“It’s a difficult, long-term concern for people to incorporate diabetes management into their daily lives without feeling like it’s taking over,” Luceri says. “I discuss diet, exercise, and maintaining healthy eating habits with patients. But when they leave my office, it’s up to them to follow that advice.”

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