Glycemic control will differ according to gender, ethnicity, culture, or marital status. The barriers for these will also be individual to each person and their current situation.

Barriers for gender can vary within cultures  and familial situations. Let’s look at some examples:

Some women prioritize the needs of others over their own. Also, studies have shown more support for men than women in regards to illness-related diabetes social support. On the flip-side, men demonstrate low self-control when relying on their spouse to maintain a healthful diet. Women with diabetes tend to have better self-control even when they do not have the support of their spouse if they are have control of food preparation. Male gender is also associated with higher incidence of congestive hear failure and peripheral atrial disease.

Studies show there is a relationship between ethnicity and self-care behaviors among those with diabetes. This can be impacted by education level, access to care and motivation. Cultural norms can also play a role in the ability of one’s self-care.

Regardless of demographics, support from friends and family is a vital piece for improved outcomes.

Social

Often immigrants face cultural barriers that effect their diabetes care. Some of these include a lack of social and medical support, low education levels, language barriers, cultural beliefs and low income. Many will face many or all of these barriers. Lack of communication can result from a language barrier  which will then lead to poor self-management skills. For some, their income level prevents them from being able to obtain proper medical care and supplies. Cultural beliefs may interfere with proper nutrition and following professional advice for glycemic control. Some diets are consist of high fats, sugars and processed foods. This can lead to poor control and difficulty with nutrition planning.

Marital status can have an impact on diabetes management. Diabetes care is influenced by marital status and the level of support from the spouse. A partners’ participation in diabetes education leads to more positive outcomes. The level of involvement from the spouse overall will influence the management of the person with diabetes. This can vary between cultures and general upbringing.

Diabetes management is strongly influenced by spiritual beliefs. Religion can provide emotional support, healing themes and a sense of belonging. These tend to result in lower rates of depression than those who have no religious ties.

As mentioned before, social support plays a significant part in diabetes management. Interventions to have improved glycemic control should not fall solely on the person with diabetes. Family members and friends can and should play an active role in learning more about diabetes, the person's specific needs and find ways to support them. However, there are many who do not have the support of others. Often people with diabetes are given well-meaning but inaccurate advise by friends and family. This can contribute to making less effective choices and unneeded stress.

Economic

Income is a key influencer for diabetes care. Diabetes has been reported to be more dominant in developing countries. The health outcomes between nations can be reflective disparities in education and economic development. Income level in any country can determine one’s ability to obtain proper care for their diabetes. Supplies needed for proper care can be costly. Often people with diabetes will ration insulin or go without adequate nutrition because they simply cannot afford what they need.

Higher education levels are associated with better glycemic control. Higher education levels also showed better outcomes in regards to self-efficacy and quality of life.

Accessibility for health insurance remains sub-par even with recent health care reforms. The lack of adequate health insurance leads to poor health outcomes including increased diabetes-related complications, and a lower quality of life.  The cost of diabetes management can be above what some can afford. Coverage for supplies and medications can vary across insurance companies making it difficult for the person with diabetes to properly manage their disease. Uninsured or underinsured patients wit limited financial resources tend to have less medical visits, have difficulty getting diabetes supplies, and generally do not have access to healthy foods. This type of poor diabetes management also leads to an increase in hospitalizations, which in-turn places more financial burden on the individual and the healthcare system. But keep in mind that lack of adequate coverage is not always related to income.

Psychological

Diabetes is a chronic disease that can impact a person physically, socially and psychologically. Depressive symptoms are more common among those with diabetes than those without. Negative mood, anger, resentment and frustration can all lead to poor self-management and poor outcomes.  It is like a two-way street because the poor outcomes can also lead to the mood disorders and depression. It is important that those struggling with depression be referred to a mental health professional.

Fatalism is defined as “a complex psychological cycle characterized by perceptions of despair, hopelessness, and powerlessness”. There are many factors involved with diabetes management. Fatalism seems to bring less medication management but is not associated with knowledge and education related to diabetes. Diabetes fatalism is more related to individual personalities rather than depression.

Interestingly, neighborhood aesthetics have a direct impact on glycemic control. This would take into account the ability to access health food, have safe places to be active and exercise, along with having nearby social support. A healthy community and neighborhood create and environment of improve self-management and health. This could include those living in a food desert. They will  have barriers to access of healthy foods and possibly adequate healthcare.