Delivering diabetes care to people in hard- to-reach groups

358 Diabetes & Primary Care Vol 13 No 6 2011 The prevalence of diabetes has almost doubled over the past few years and is expected to rise further (Diabetes UK, 2010). In parallel with the growing challenge of diabetes and its complications, the past few decades have witnessed several advances in the field of diabetes. Better insights into the pathogenesis of diabetes, availability of new therapies, importance of risk factor control and structured care delivery have all transformed the way in which most people with diabetes receive their care (American Diabetes Association [ADA], 2011a). However, inequalities in access to health care persist, and while a majority of people are able to access improved diabetes care, there are still groups that are hard to reach and fail to receive the same standard of care. Examples of such hard-to-reach groups include people with mental health problems, those in correctional institutions, adolescents, homeless people, migrant ethnic groups and older people (Diabetes UK, 2006; a PCDS CPD module on diabetes management in older people is available online). Although the complex socioeconomic and cultural factors that define each of these groups are unique, they do have many similarities. These groups remain on the fringes of our healthcare system, have irregular contact with healthcare professionals and may often present as emergencies or with advanced complications. Healthcare professionals’ ability to deliver high-quality care to these groups is further compromised by the paucity of scientific evidence and the lack of understanding of their needs. This article summarises some of the Delivering diabetes care to people in hardto-reach groups