title: Barriers to the delivery of diabetes care in the Middle East and South Africa: a survey of 1,082 practising physicians in five countries.
abstract: OBJECTIVE
  Developing countries face a high and growing burden of type 2 diabetes. We surveyed physicians in a diverse range of countries in the Middle East and Africa (Egypt, Kingdom of Saudi Arabia, United Arab Emirates, South Africa and Lebanon) with regard to their perceptions of barriers to type 2 diabetes care identified as potentially important in the literature and by the authors.
  
  
  METHODS
  One thousand and eighty-two physicians completed a questionnaire developed by the authors.
  
  
  RESULTS
  Most physicians enrolled in the study employed guideline-driven care; 80-100% of physicians prescribed metformin (with lifestyle intervention, where there are no contraindications) for newly diagnosed type 2 diabetes, with lifestyle intervention alone used where metformin was not prescribed. Sulfonylureas were prescribed widely, consistent with the poor economic status of many patients. About one quarter of physicians were not undertaking any form of continuing medical education, and relatively low proportions of practices had their own diabetes educators, dieticians or diabetic foot specialists. Physicians identified the deficiencies of their patients (unhealthy lifestyles, lack of education and poor diet) as the most important barriers to optimal diabetes care. Low-treatment compliance was not ranked highly. Access to physicians did not appear to be a problem, as most patients were seen multiple times per year.
  
  
  CONCLUSIONS
  Physicians in the Middle East and South Africa identified limitations relating to their patients as the main barrier to delivering care for diabetes, without giving high priority to issues relating to processes of care delivery. Further study would be needed to ascertain whether these findings reflect an unduly physician-centred view of their practice. More effective provision of services relating to the prevention of complications and improved lifestyles may be needed.
authors.affiliation: Alexandria Faculty of Medicine, Alexandria University, Egypt.
authors.forename: S H
authors.initials: SH
authors.lastname: Assaad-Khalil
authors.forename: M
authors.initials: M
authors.lastname: Al Arouj
authors.forename: M
authors.initials: M
authors.lastname: Almaatouq
authors.forename: A
authors.initials: A
authors.lastname: Amod
authors.forename: S N
authors.initials: SN
authors.lastname: Assaad
authors.forename: S T
authors.initials: ST
authors.lastname: Azar
authors.forename: J
authors.initials: J
authors.lastname: Belkhadir
authors.forename: K
authors.initials: K
authors.lastname: Esmat
authors.forename: A A K
authors.initials: AA
authors.lastname: Hassoun
authors.forename: N
authors.initials: N
authors.lastname: Jarrah
authors.forename: S
authors.initials: S
authors.lastname: Zatari
authors.forename: K G M M
authors.initials: KG
authors.lastname: Alberti
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy*; D004501:Education, Medical / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008877:Middle East; D010465:Perception; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care; D013019:South Africa; D011795:Surveys and Questionnaires
chemical_list: D007004:Hypoglycemic Agents