Barriers to managing diabetes
The Booth et al. study of recently diagnosed patients with diabetes and the health professionals involved in their care highlighted barriers to lifestyle management in six main areas. The article provides valuable insights into how to improve the experiences of Britain’s 2.9 million individuals with diabetes.
During interviews, Booth and her team found that patients felt “left in the dark” and unsure about what they could and couldn’t eat whilst waiting to receive any formal diabetes education, which patients reported could take months. The research carried out at Queen’s University Belfast, explored the views of people recently diagnosed with diabetes through focus groups and discovered that whilst waiting for a referral to a diabetes education programme, they received little or no information about what to eat. One patient reported that that were “eating enough to stay alive but eating very little” after being told they needed to lower their blood sugar (glucose) levels by their doctor.
Once contact was made with a health professional there was a consensus that it was a case of information overload for the newly diagnosed patient. A lack of understanding and knowledge were reported as being evident in patient discussions, with confusion around carbohydrates, portion sizes and sugar vs. fat frequently observed. This lack of knowledge and confusion was reported even though all the patients had attended education sessions prior to the focus groups. Therefore Booth and her team state that ‘the provision of information in stages alongside access to resources that can be used by patients in their own time’ could be a way for health professionals to help people with diabetes understand the lifestyle changes required to manage their condition.
Combining the focus groups with in-depth interviews with health professionals, Booth et al. report that another significant barrier was the view of having to ‘break the habits of a lifetime’. This was partnered with patients negatively viewing the dietary changes advised by health professionals as mundane, unappealing and restrictive. A feeling echoed by the professionals summarised with a dietitian’s quote in the article of “it’s getting them to hear what you are saying rather than just honing on the ‘life’s not worth living any more’ if they’ve gotta cut out X,Y and Z” .
Barriers to increasing physical activity levels were also mentioned by both professionals and patients, these mainly related to physical restrictions due to co-morbidities which were common amongst patients or environmental factors such as slippery paths in the winter. Therefore health professionals need to be aware of these barriers and take them into consideration, so they can tailor physical activity advice to the individual patient’s ability, so as to encourage an active and healthy lifestyle.
Conducted during the festive season, the focus groups highlighted the difficulties that people with diabetes find combining their needs with that of both their family and social lives. The temptations on offer at social gatherings, combined with the frequent lack of healthier choices, were highlighted by both patients and health professionals as a challenge that many could not resist. Families and friends not being mindful or sympathetic towards people with diabetes also adds to the difficulties of those trying to stick with their recommended diets.
With 2.9 million people in the UK diagnosed with diabetes 1 this research highlights the need for improved support between the point of diagnosis and the first visit with a professional for diabetes education. Easy to understand resources and support needs to be developed and made available to patients during this time in order, to limit the feelings of isolation presently reported.
The full paper, Diet and physical activity in the self-management of type 2 diabetes: Barriers and facilitators identified by patients and health professionals, can be accessed for free here.
1. Diabetes UK http://www.diabetes.org.uk accessed 04-10-12
This study was supported by a research grant from Sugar Nutrition UK. The funding source had no involvement in the research process or in production of the published manuscript.