Identifying Key Moments in Type 2 Diabetes Management: A Qualitative Study of the Experiences of People With Type 2 Diabetes and Diabetes Health Coaches

Overview

Journal Health Expect

Publisher Wiley

Specialty Public Health

Date 2024 Nov 21

PMID 39572877

Authors

Jack B Joyce

Carolyn Newbert

Nicola Guess

Kate Fryer

Caroline A Mitchell

Liliia Bespala

Elizabeth Morris

Paul Aveyard

Susan A Jebb

Charlotte Albury

Affiliations

Soon will be listed here.

Abstract

Objective: For people with type 2 diabetes who are overweight, weight loss increases the likelihood of achieving diabetes remission. The aim here was to draw on the experiences of people living with type 2 diabetes and coaches who deliver type 2 diabetes prevention and remission programmes. This was done to develop a service that increases the proportion of people who achieve remission by identifying an effective weight management service.

Research Design And Methods: A qualitative researcher and co-researcher with type 2 diabetes conducted 37 narrative interviews with adults with type 2 diabetes (October 2022-June 2023) and 16 semi-structured interviews with health coaches delivering type 2 diabetes programmes in England. Data were analysed using Reflexive Thematic Analysis. Participants were diverse in ethnicity, socioeconomic status, age, gender and years since diabetes diagnosis.

Results: Four themes were generated relating to moments in a person's diabetes care: (1) coming to terms with diagnosis, (2) lightbulb moments, (3) sustaining change as normal and (4) becoming expert/building confidence. These four themes were united under a high-level interpretivist theme: 'Same journey, different experience', capturing the mismatch between a linear rigid care pathway described by coaches and the diversity of experience of people living with type 2 diabetes.

Conclusions: Coaches and people with type 2 diabetes are aligned on their reports of key moments in adapting to diabetes. Participants' desire for flexibility in their care contrasted with coach reports of rigid service provision. These insights may enable more people with type 2 diabetes to engage and adhere to weight management services aimed at diabetes remission.

References

Sjostrom L, Peltonen M, Jacobson P, Ahlin S, Andersson-Assarsson J, Anveden A . Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014; 311(22):2297-304. DOI: 10.1001/jama.2014.5988. View

Browne J, Ventura A, Mosely K, Speight J . 'I call it the blame and shame disease': a qualitative study about perceptions of social stigma surrounding type 2 diabetes. BMJ Open. 2013; 3(11):e003384. PMC: 3840338. DOI: 10.1136/bmjopen-2013-003384. View

Alazri M, Neal R . The association between satisfaction with services provided in primary care and outcomes in Type 2 diabetes mellitus. Diabet Med. 2003; 20(6):486-90. DOI: 10.1046/j.1464-5491.2003.00957.x. View

Speight J, Skinner T, Huber J, Lake A, Messina R, Mocan A . A PSAD Group response to the consensus report on the definition and interpretation of remission in type 2 diabetes: a psychosocial perspective is needed. Diabetologia. 2021; 65(2):406-408. DOI: 10.1007/s00125-021-05615-z. View

Kearney M, OSullivan J . Identity shifts as turning points in health behavior change. West J Nurs Res. 2003; 25(2):134-52. DOI: 10.1177/0193945902250032. View

Di Lorito C, Bosco A, Birt L, Hassiotis A . Co-research with adults with intellectual disability: A systematic review. J Appl Res Intellect Disabil. 2017; 31(5):669-686. DOI: 10.1111/jar.12435. View

Speight J, Holmes-Truscott E, Garza M, Scibilia R, Wagner S, Kato A . Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations. Lancet Diabetes Endocrinol. 2023; 12(1):61-82. DOI: 10.1016/S2213-8587(23)00347-9. View

Himmelstein M, Puhl R . At multiple fronts: Diabetes stigma and weight stigma in adults with type 2 diabetes. Diabet Med. 2020; 38(1):e14387. DOI: 10.1111/dme.14387. View

Ogden J, Hills L . Understanding sustained behavior change: the role of life crises and the process of reinvention. Health (London). 2008; 12(4):419-37. DOI: 10.1177/1363459308094417. View

10.

Malterud K, Siersma V, Guassora A . Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. 2015; 26(13):1753-1760. DOI: 10.1177/1049732315617444. View

11.

Nagar S, Napoles A, Jordan I, Marino-Ramirez L . Socioeconomic deprivation and genetic ancestry interact to modify type 2 diabetes ethnic disparities in the United Kingdom. EClinicalMedicine. 2021; 37:100960. PMC: 8343245. DOI: 10.1016/j.eclinm.2021.100960. View

12.

House A, Bryant L, Russell A, Wright-Hughes A, Graham L, Walwyn R . Managing with Learning Disability and Diabetes: OK-Diabetes - a case-finding study and feasibility randomised controlled trial. Health Technol Assess. 2018; 22(26):1-328. PMC: 5994644. DOI: 10.3310/hta22260. View

13.

Hart K, Kubilius A, Clark M . Psycho-social factors associated with type two diabetes remission through lifestyle intervention: A scoping review. PLoS One. 2023; 18(11):e0294344. PMC: 10653481. DOI: 10.1371/journal.pone.0294344. View

14.

Zhou X, Zeng C . Diabetes remission of bariatric surgery and nonsurgical treatments in type 2 diabetes patients who failure to meet the criteria for surgery: a systematic review and meta-analysis. BMC Endocr Disord. 2023; 23(1):46. PMC: 9945737. DOI: 10.1186/s12902-023-01283-9. View

15.

Ojo A, Nnyanzi L, Giles E, Ells L, Okeke S, Ajayi K . "I am not really into the government telling me what I need to eat": exploring dietary beliefs, knowledge, and practices among ethnically diverse communities in England. BMC Public Health. 2023; 23(1):800. PMC: 10152749. DOI: 10.1186/s12889-023-15689-6. View

16.

Pearl R, Wadden T, Chao A, Walsh O, Alamuddin N, Berkowitz R . Weight Bias Internalization and Long-Term Weight Loss in Patients With Obesity. Ann Behav Med. 2018; 53(8):782-787. PMC: 6636884. DOI: 10.1093/abm/kay084. View

17.

Sattar N, Welsh P, Leslie W, Thom G, McCombie L, Brosnahan N . Dietary weight-management for type 2 diabetes remissions in South Asians: the South Asian diabetes remission randomised trial for proof-of-concept and feasibility (STANDby). Lancet Reg Health Southeast Asia. 2023; 9:100111. PMC: 9904218. DOI: 10.1016/j.lansea.2022.100111. View

18.

Thom G, Messow C, Leslie W, Barnes A, Brosnahan N, McCombie L . Predictors of type 2 diabetes remission in the Diabetes Remission Clinical Trial (DiRECT). Diabet Med. 2020; 38(8):e14395. DOI: 10.1111/dme.14395. View

19.

Peel E, Parry O, Douglas M, Lawton J . Diagnosis of type 2 diabetes: a qualitative analysis of patients' emotional reactions and views about information provision. Patient Educ Couns. 2004; 53(3):269-75. DOI: 10.1016/j.pec.2003.07.010. View

20.

Hadjiconstantinou M, Dunkley A, Eborall H, Robertson N, Khunti K, Davies M . Perceptions of healthcare professionals and people with type 2 diabetes on emotional support: a qualitative study. BJGP Open. 2020; 4(1). PMC: 7330186. DOI: 10.3399/bjgpopen20X101018. View