There are a number of key service factors that pose barriers to good prevention of complications. These include:

1. Incomplete/inadequate screening for DM, poor follow-up of cases detected.

2. Once a general practitioner refers a patient to specialist care, many patients are not referred back to the practitioner. The practitioner may not hear any more about the patient, and assume they are being taken care of. (This is often because endocrinologists do not trust their GP colleagues, in part because of the poor postgraduate training in Hong Kong in primary care.)

3. Both clinic and GP may assume the other is doing the monitoring. Poor communication and liaison regarding shared care is a major factor in breakdown of continuity of care.

4. Medical records are often inadequate and do not enable patients to take information from doctor to doctor. Patient-held records would be helpful here but are opposed by the profession because of fears about liability and patients "finding out too much".

5. Patient education has a low priority, is of little interest among doctors and nurse who feel too busy with "real medicine" to carefully educate patients about their care and address their questions. Specialist Diabetic Nurses can help here.