Clinical Barriers To Optimal Glycemic Control

Maintenance of near-normal glucose levels is demanding, in that it requires an educated and motivated patient to coordinate the complex task of adjusting insulin doses based upon ambient glucose levels, dietary intake, activity, illness, or stress. Although psychosocial barriers such as lack of economic or social support, poor access to specialized centers, eating disorders, and other psychological problems are associated with poor control (6), factors inherent in insulin therapy contribute to the challenge of keeping glucose levels in the near-normal range (Table 1).

Table 1 Clinical Barriers Associated with Insulin Therapy

Increased risk of hypoglycemia

Risk increases exponentially as patients approach

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