LAUSR

This is an interesting pilot study, which makes use of a quasi-experimental design. The study is carried out in rural Indonesia. Previous studies have shown that in Western societies accurate follow-up and adherence to therapy are widespread problems and, in a rural setting, due to the scarcity of facilities, these problems are even bigger. Disparities between rural and urban diabetics seem to be mainly explained by the lack of an infrastructure capable of sustaining the processes required to improve care and outcomes. Individuals living in rural communities often have to travel longer distances to obtain appropriate healthcare, which has been strongly associated with poorer glycemic control. Access to diabetes specialists is scarcer in rural centres, and general practitioners are less likely to adhere to the official standards of diabetes care. Furthermore, the lack of a multidisciplinary team increases the burden on the healthcare provider, who, with limited time and resources, has to both educate and treat the patient, often with poor clinical information systems and/or preventive health services and isolated from diabetes education programmes. Previous research showed that several important factors are associated with exacerbated barriers in adequate diabetes self-management, including financial strains, cultural barriers, mistrust, communication issues, and high rates of health illiteracy. Self-management of diabetes mellitus is important to avoid acute and long-term complications. The role of specialised nurses is particularly important in the education of self-care in diabetics. Healthcare professionals who are not diabetes educators are far too often called upon to teach diabetes patients techniques of self-care with poor results. It is essential to the daily life and future of people with diabetes that they understand and practise self-care, so they can manage a disease that can be devastating if it is left unchecked. For communication barriers related to foreign language, it is important to have a professional translator or use pamphlets and instructional material in the native tongue of the patient. Achieving patient behavioural change is an extremely important outcome but it is very hard to obtain. As the