Marisol, a 58-year-old client with type 2 diabetes, has missed her last three follow-up appointments at the community clinic. During a home visit, the nurse learns Marisol works two part-time jobs with no paid time off and relies on a neighbor for rides since her car was repossessed. Her most recent A1c drawn six months ago was 9.8%, and she reports rationing her insulin because refills require an in-person visit she cannot get to. Which factor is the most likely underlying cause of Marisol's poor glycemic control?
- Personal preference for alternative or herbal remedies over prescribed therapy
- Limited transportation and inflexible work schedules restricting access to care
- Insufficient understanding of how insulin works
- A lack of motivation to manage her chronic condition