Exploring the Experiences and Perspectives of Insulin Therapy in Type 2 Diabetes Via Web-Based UK Diabetes Health Forums: Qualitative Thematic Analysis of Threads

Overview

Journal JMIR Diabetes

Specialty Endocrinology

Date 2022 Oct 5

PMID 36197724

Authors

Maya Allen-Taylor

Laura Ryan

Kirsty Winkley

Rebecca Upsher

Affiliations

Soon will be listed here.

Abstract

Background: Despite the advent of type 2 diabetes (T2D) remission strategies and novel therapeutic agents, many individuals with T2D will require insulin treatment to achieve target glycemia, with the aim of preventing or delaying diabetes complications. However, insulin refusal and cessation of treatment in this group are common, and their needs are underreported and relatively unexplored.

Objective: This study aimed to explore the experiences and perspectives of individuals with T2D for whom insulin therapy is indicated as expressed on web-based health forums, in order to inform the development of evidence-based structured educational and support strategies and improve health care provider awareness.

Methods: Retrospective archived forum threads from the 2 largest, freely and publicly accessible diabetes health forums in the United Kingdom were screened over a 12-month period (August 2019-2020). The Diabetes UK and Diabetes.co.uk forums were searched for relevant threads. A total of 3 independent researchers analyzed the forum threads and posts via thematic analysis. Pertinent themes were identified and illustrated by paraphrasing members' quotes to ensure anonymity. A total of 299 posts from 29 threads from Diabetes UK and 295 posts from 28 threads Diabetes.co.uk were analyzed over the study period. In all, 57 threads met the inclusion criteria and were included in the final analysis.

Results: Four overarching themes were generated to illustrate the unmet needs that prompted members to seek information, advice, and support regarding insulin therapy outside of their usual care provision via the forums: empowerment through sharing self-management strategies, seeking and providing extended lifestyle advice, relationships with health care professionals, and a source of psychological peer support.

Conclusions: This is the first study to collect data from web-based health forums to characterize the experiences and perspectives of people with T2D for whom insulin therapy is indicated. The observed naturalistic conversations have generated useful insights; our findings suggest that there are significant unmet self-management and psychological needs within this group that are not being met elsewhere, prompting the seeking of information and support on the web. These include practical aspects such as insulin injection technique, storage and dose titration, driving and travel considerations, the emerging use of technology, and a strong interest in the effects of extended lifestyle (diet and activity) approaches to support insulin therapy. In addition, problematic relationships with health care professionals appear to be a barrier to effective insulin therapy for some. In contrast, seeking and offering mutually beneficial, practical, and psychological support from peers was viewed as enabling. The study results will help to directly inform insulin-focused self-management and support strategies to enable individuals in this group to achieve their best outcomes.

References

Hadjiyianni I, Desai U, Suzuki S, Ivanova J, Cao D, Kirson N . Basal Insulin Persistence, Associated Factors, and Outcomes After Treatment Initiation: A Retrospective Database Study Among People with Type 2 Diabetes Mellitus in Japan. Diabetes Ther. 2016; 8(1):149-166. PMC: 5306114. DOI: 10.1007/s13300-016-0215-6. View

Thomas D, Elliott E, Naughton G . Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006; (3):CD002968. PMC: 8989410. DOI: 10.1002/14651858.CD002968.pub2. View

Patel R, Smeraldi F, Abdollahyan M, Irving J, Bessant C . Analysis of mental and physical disorders associated with COVID-19 in online health forums: a natural language processing study. BMJ Open. 2021; 11(11):e056601. PMC: 8573296. DOI: 10.1136/bmjopen-2021-056601. View

Buse J, Wexler D, Tsapas A, Rossing P, Mingrone G, Mathieu C . 2019 update to: Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2019; 63(2):221-228. DOI: 10.1007/s00125-019-05039-w. View

Tian Q, Upsher R, Winkley K . Systematic review and meta-analysis of diabetes specialist delivered insulin education for adults with type 2 diabetes in outpatient settings. Patient Educ Couns. 2021; 105(4):835-842. DOI: 10.1016/j.pec.2021.06.030. View

Vydiswaran V, Reddy M . Identifying peer experts in online health forums. BMC Med Inform Decis Mak. 2019; 19(Suppl 3):68. PMC: 6448182. DOI: 10.1186/s12911-019-0782-3. View

Roussel R, Charbonnel B, Behar M, Gourmelen J, Emery C, Detournay B . Persistence with Insulin Therapy in Patients with Type 2 Diabetes in France: An Insurance Claims Study. Diabetes Ther. 2016; 7(3):537-49. PMC: 5014791. DOI: 10.1007/s13300-016-0185-8. View

DeFronzo R . Pathogenesis of type 2 diabetes mellitus. Med Clin North Am. 2004; 88(4):787-835, ix. DOI: 10.1016/j.mcna.2004.04.013. View

Peyrot M, Barnett A, Meneghini L, Schumm-Draeger P . Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study. Diabet Med. 2012; 29(5):682-9. PMC: 3433794. DOI: 10.1111/j.1464-5491.2012.03605.x. View

10.

Yang Z, Scott C, Mao C, Tang J, Farmer A . Resistance exercise versus aerobic exercise for type 2 diabetes: a systematic review and meta-analysis. Sports Med. 2013; 44(4):487-99. DOI: 10.1007/s40279-013-0128-8. View

11.

Cody W . Paternalism in nursing and healthcare: central issues and their relation to theory. Nurs Sci Q. 2003; 16(4):288-96. DOI: 10.1177/0894318403257170. View

12.

Grosberg D, Grinvald H, Reuveni H, Magnezi R . Frequent Surfing on Social Health Networks is Associated With Increased Knowledge and Patient Health Activation. J Med Internet Res. 2016; 18(8):e212. PMC: 4997002. DOI: 10.2196/jmir.5832. View

13.

Holden S, Gale E, Jenkins-Jones S, Currie C . How many people inject insulin? UK estimates from 1991 to 2010. Diabetes Obes Metab. 2014; 16(6):553-9. DOI: 10.1111/dom.12260. View

14.

Whicher C, ONeill S, Holt R . Diabetes in the UK: 2019. Diabet Med. 2020; 37(2):242-247. DOI: 10.1111/dme.14225. View

15.

Chewcharat A, Prasitlumkum N, Thongprayoon C, Bathini T, Medaura J, Vallabhajosyula S . Efficacy and Safety of SGLT-2 Inhibitors for Treatment of Diabetes Mellitus among Kidney Transplant Patients: A Systematic Review and Meta-Analysis. Med Sci (Basel). 2020; 8(4). PMC: 7712903. DOI: 10.3390/medsci8040047. View

16.

Dyson P, Twenefour D, Breen C, Duncan A, Elvin E, Goff L . Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabet Med. 2018; 35(5):541-547. DOI: 10.1111/dme.13603. View

17.

Dias A, Chomutare T, Botsis T . Exploring the community structure of a diabetes forum. Stud Health Technol Inform. 2012; 180:833-7. View

18.

Perez-Nieves M, Kabul S, Desai U, Ivanova J, Kirson N, Cummings A . Basal insulin persistence, associated factors, and outcomes after treatment initiation among people with type 2 diabetes mellitus in the US. Curr Med Res Opin. 2015; 32(4):669-80. DOI: 10.1185/03007995.2015.1135789. View

19.

Ng C, Lai P, Lee Y, Azmi S, Teo C . Barriers and facilitators to starting insulin in patients with type 2 diabetes: a systematic review. Int J Clin Pract. 2015; 69(10):1050-70. DOI: 10.1111/ijcp.12691. View

20.

Halliday J, Speight J, Bennet A, Beeney L, Hendrieckx C . The Diabetes and Emotional Health Handbook and Toolkit for Health Professionals Supporting Adults With Type 1 and Type 2 Diabetes: Formative Evaluation. JMIR Form Res. 2020; 4(2):e15007. PMC: 7060499. DOI: 10.2196/15007. View