Availability of diabetes education
The need for more diabetes educators to serve the numbers of people with the disease is a common challenge. In urban areas of some countries, up to 30-40% of people can be reached through a diabetes education facility. However, in rural or less developed communities, this number may drop to zero. People in rural areas may have to travel for days to access specialist services.

The sheer number of people with diabetes may overwhelm the resources available for treatment and education Similarly, the demand for normoglycaemia may place impossible expectations on healthcare professionals and patients alike.

Diabetes is not seen as a serious disease
Poor appreciation of the seriousness of diabetes is found amongst healthcare professionals and patients, alike. Physicians and healthcare providers who tell their patients that "your sugar is a little high, just watch what you eat" or use terms such as 'borderline' or 'mild diabetes' are demonstrating a lack of awareness of the disease that is passed on to the patients. This attitude is also apparent in the care provided where, too often, patients are not aggressively managed in order to achieve target blood glucose levels. Delays in starting people with Type 2 diabetes on insulin once oral glucose-lowering agents have failed can have far-reaching implications. Patient empowerment can also be neglected. People are often not referred to diabetes education until they have a problem, where an earlier referral might have avoided it altogether.

Psychosocial issues and patient attitudes to the disease are largely overlooked, but these are important in putting the education received into practice. Patients and their families may consider Type 2 diabetes to be less serious than other diseases if they receive this impression from their physician. This can add to the inertia of making difficult lifestyle changes, particularly where symptoms of diabetes and its complications are not yet present or significant.

Cost
Cost is a major issue in diabetes management. For the patient, the outlay on pharmaceuticals, insulin, glucose meters and test strips can be substantial, which can hamper optimal self-management. The cost of diabetes education can also be an issue. In some countries the person with diabetes may not have to pay for education; however, there are costs involved in taking time off work to attend diabetes education courses and in travelling to the diabetes centres providing them.

For the healthcare provider, a key issue is the lack of trained educators. This can be linked to the lack of resources, ability and/or facilities for training diabetes educators. Funds for hiring a diabetes educator and for setting up an education programme have to be sourced.