title: Barriers to the treatment of adolescent type 2 diabetes--a survey of provider perceptions.
abstract: OBJECTIVE
  Type 2 diabetes mellitus (T2DM) is increasingly common among children and adolescents. However, achievement of good metabolic control has been difficult in this population. The aim of this study was to survey pediatric endocrine and diabetes specialists regarding the issues they consider to be barriers to successful treatment of adolescent T2DM.
  
  
  METHODS
  An electronic questionnaire was administered to 220 physicians and nurses attending a conference on pediatric diabetology in 2001.
  
  
  RESULTS
  The issues that were most strongly perceived as barriers to successful treatment of adolescents with T2DM were prevalence of high-risk lifestyle in other family members (98%), lack of immediate risk to life reducing patient motivation (89%), lack of guidelines regarding optimal treatment (73%), prevalence of behavioral and/or psychiatric disorders (71%), and cultural/language barriers (65%). The survey also revealed that in the majority of clinics, T2DM education programs were not designed specifically for type 2 patients nor delivered by a specifically trained education team. Furthermore, despite the fact that cultural and ethnic differences were identified as important barries to care, educational materials designed for particular racial and cultural groups were used in only 37% of the clinics.
  
  
  CONCLUSIONS
  This survey identifies a number of areas perceived by clinicians to be significant barriers to successful treatment of T2DM in adolescent patients. Given the multiple challenges identified by the survey, programs addressed specifically to the characteristics of adolescents with T2DM will be necessary, including materials appropriate to the developmental stage and ethnic background of patients.
authors.affiliation: Maccabi Health Care Services, Juvenile Diabetes Center, Hod-Hasharon, Israel. Hamiels@012.net.il
authors.forename: Orit
authors.initials: O
authors.lastname: Pinhas-Hamiel
authors.forename: Philip
authors.initials: P
authors.lastname: Zeitler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003469:Culture; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D004704:Endocrinology; D005190:Family; D005260:Female; D006801:Humans; D007802:Language; D008019:Life Style; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D009726:Nurses; D010349:Patient Compliance; D010353:Patient Education as Topic; D010372:Pediatrics; D010820:Physicians; D012307:Risk Factors; D011795:Surveys and Questionnaires