Perceived Barriers to Self-Management Among Adults with Uncontrolled Type 2 Diabetes Mellitus: A Cross-Sectional Study in Pakistan

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a leading non-communicable disease globally, with low- and middle-income countries such as Pakistan bearing a disproportionate burden. Despite strong evidence supporting self-management for glycemic control, patients in resource-limited settings often face multidimensional barriers that compromise adherence and outcomes. Objective: This study aimed to identify and quantify perceived barriers to effective self-management among adults with uncontrolled T2DM in Pakistan. Methods: A descriptive cross-sectional study was conducted among 376 adults with HbA1c >7%, recruited through consecutive sampling from outpatient departments of three public hospitals in Central Punjab, Pakistan. Data were collected using a structured, interviewer-administered questionnaire assessing five domains of self-management barriers—knowledge/information, physical/functional, psychosocial/cultural, economic/structural, and healthcare system/provider-related. Descriptive and comparative analyses were performed using SPSS version 25. Results: Participants’ mean age was 53.3 years (SD = 9.6); most were male (57%) and rural residents (78%). The most prevalent barriers were economic (68.2%), psychosocial (63.5%), and health-system related (59.4%). Major obstacles included difficulty affording monitoring supplies (77.7%), diabetes-related distress (74.2%), and short consultation times (74.2%). Barriers were more common among low-education and rural participants. Conclusion: Adults with uncontrolled T2DM in Pakistan face intersecting financial, psychosocial, and systemic challenges that hinder self-management. Integrating culturally adapted diabetes self-management education, financial protection for essential supplies, and psychosocial counseling into primary care is essential to improve glycemic outcomes.