Implementing guidelines can be difficult because it requires effort and change in practices by health care personnel who may already be used to managing diabetes in their own way, and who may have time and resource constraints.

In 2009, Goderis et al evaluated the experiences of general practitioners who participated in a Quality Improvement Program with the goal of promoting adherence to international guidelines for diabetes care. The barriers to change that they found included the general practitioner’s inadequate knowledge on the management of care, their own performance in managing practices, attitudes regarding targets, medications, and skepticism about quality improvement projects. From the patient’s perspective, lack of knowledge on diet, health status, attitude and motivation, and clinic practice organization and staff were the major barriers to optimal diabetes care. More general context barriers included lack of teamwork, poor relationships between and with health care providers (including competition between specialists and general practitioners), financial concerns, and factors associated with patient aging.
 

Successful management of diabetes depends heavily on removing barriers for optimal care experienced by both providers and patients. The authors suggested that multifaceted quality improvement programs may be better at improving management than single interventions.