However, given that a majority of adults do not know they have DM, the problem may lie elsewhere. One important problem lies with medical practitioners. This issue is three-fold.

First, many doctors do not screen patients for DM opportunistically. They only treat the symptom that brought the patient to them. They do not perform preventive activities, such as screening because there is not motive for them to do so.

Second, once DM is detected, many practitioners still fail to provide sufficient information in a way that is accessible and retainable by patients. Patients may be told they have DM, they may have an explanation of what that means, and they may have some recollection of the information given. However, it is likely that at each of these nodes there is breakdown of communication, understanding or retention. In other words, patients don’t fully comprehend what it means to have DM or that lifestyle change is necessary, not optional.

Third, there is often a failure to screen patients for complications by medical practitioners. Because patients can visit any medical practitioner, there is no continuity of care. Breakdown in continuity of care means that it may be many years between screening checks for retinopathy or foot deterioration. Patients may only present when symptoms become apparent, usually by which time the damage is done.

Patients who do not fully appreciate the requirements for adherence to dietary, exercise and medication are less likely to comply. They may be anxious about their diagnosis, or find it difficult to adopt a changed lifestyle when all their family members continue and expect their usual lifestyle. There may be a poor doctor-patient relationship and low satisfaction with quality of care. Finally, patients may not realise the consequences of adherence to lifestyle and treatment, or find themselves unable to give up favorite foods, for example.