Decolonizing Diabetes

This article presents insights into the colonial experience of Indigenous Peoples living with type 2 diabetes within seven First Nation communities in Northern Ontario. A constructivist grounded theory methodology, guided by a decolonizing and participatory action approach to conducting research with Indigenous Peoples, was utilised in this study. Twenty-two individuals with type 2 diabetes were interviewed. The main research question explored the impact of colonization on the lived experience and perceptions about developing type 2 diabetes for Indigenous Peoples. Using semi-structured interviews, the three main categories that emerged from the analysis of the interview transcripts were changing ways of eating, developing diabetes, and choosing your medicine. A substantive theory was developed that suggests that Indigenous Peoples, with type 2 diabetes, often live with the perception that there is ‘no going back’ to the way things once were prior to European contact. As a result, they have adapted the way they live with diabetes which can, at times, be at odds with Indigenous world views. An adaptation that considers a complementary approach to the way individuals live and manage diabetes including both Traditional and Western ways may provide a framework for a decolonized model of type 2 diabetes care for Indigenous Peoples.

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Provision of services in primary care for type 2 diabetes: a qualitative study with patients, GPs, and nurses in the East of England

British Journal of General Practice ◽

10.3399/bjgp20x710945 ◽

2020 ◽

Vol 70 (698) ◽

pp. e668-e675

Author(s):

Hajira Dambha-Miller ◽

Simon J Griffin ◽

Ann Louise Kinmonth ◽

Jenni Burt

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Care Provision ◽

Structured Interviews ◽

High Quality ◽

Face To Face ◽

Healthcare Experiences ◽

Provision Of Services ◽

The Impact

BackgroundThere is little evidence on the impact of national pressures on primary care provision for type 2 diabetes from the perspectives of patients, their GPs, and nurses.AimTo explore experiences of primary care provision for people with type 2 diabetes and their respective GPs and nurses.Design and settingA qualitative primary care interview study in the East of England.MethodSemi-structured interviews were conducted, between August 2017 and August 2018, with people who have type 2 diabetes along with their respective GPs and nurses. Purposive sampling was used to select for heterogeneity in glycaemic control and previous healthcare experiences. Interviews were audio-recorded and analysed thematically. The consolidated criteria for reporting qualitative research were followed.ResultsThe authors interviewed 24 patients and 15 GPs and nurses, identifying a changing landscape of diabetes provision owing to burgeoning pressures that were presented repeatedly. Patient responders wanted GP-delivered care with continuity. They saw GPs as experts best placed to support them in managing diabetes, but were increasingly receiving nurse-led care. Nurses reported providing most of the in-person care, while GPs remained accountable but increasingly distanced from face-to-face diabetes care provision. A reluctant acknowledgement surfaced among GPs, nurses, and their patients that only minimum care standards could be maintained, with aspirations for high-quality provision unlikely to be met.ConclusionType 2 diabetes is a tracer condition that reflects many aspects of primary care. Efforts to manage pressures have not been perceived favourably by patients and providers, despite some benefits. Reframing expectations of care, by communicating solutions to both patients and providers so that they are understood, managed, and realistic, may be one way forward.

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Dental Students’ Perceptions of ESP Material and its Impact on Their Language Proficiency: A Case Study of a Saudi Arabian University

10.31235/osf.io/z8db4 ◽

2020 ◽

Author(s):

Uzma M Hashmi ◽

Hussam Rajab ◽

Asrar Ehsan Sindi

Keyword(s):

Language Proficiency ◽

English Language ◽

Research Question ◽

Saudi Arabian ◽

Dental Students ◽

Future Research ◽

Structured Interviews ◽

Main Research ◽

Classroom Activities ◽

The Impact

The paper aims to explore the dental English for Specific Purposes (ESP) students’ perceptions of the ESP material and its influence on their English proficiency in the dentistry department of a Saudi Arabian university. The study adopts a qualitative technique of semi-structured interviews to elicit the views of 12 purposively chosen participants. The process of a thematic analysis of the qualitative data led to the emergence of three overarching themes that aimed to answer the main research question which is how the dental students in the Saudi context perceive the ESP materials and the impact these materials have on their language proficiency. The key findings indicate that the ESP learners in the dentistry department have a very positive attitude towards learning the English language in general and ESP in particular. Their awareness of their linguistic needs makes it a significant study in the field of ESP in Saudi Arabia. The results also suggest that the coursebook contents and material are outdated and inappropriate for the ESP learners in the Saudi English as a Foreign Language (EFL) context. The findings illustrate that the ESP teachers need to use the English language in classrooms and introduce learner-centred interactive activities to encourage students to participate in classroom activities. In light of the findings, the study outlines the implications and gives directions for future research.

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A secondary qualitative analysis exploring the emotional and physical challenges of living with type 2 diabetes

British Journal of Diabetes ◽

10.15277/bjd.2021.309 ◽

2021 ◽

Author(s):

Michelle Hadjiconstantinou ◽

Helen Eborall ◽

Jacqui Troughton ◽

Noelle Robertson ◽

Kamlesh Khunti ◽

...

Keyword(s):

Type 2 Diabetes ◽

Qualitative Analysis ◽

Diabetes Management ◽

Well Being ◽

Daily Routine ◽

Structured Interviews ◽

Biographical Disruption ◽

Emotional Challenges ◽

The Impact

Background: Many feel that their new identity as ‘someone living with diabetes’ does not fit with their biography. Some individuals may be able to re-assess life goals, adapt their identity and adjust to living with type 2 diabetes mellitus (T2DM). For others, the biographical disruption experienced with their condition may negatively affect their emotional well-being and identity. Aim: To conceptualise and explore the emotional challenges experienced living with T2DM, using biographical disruption as analytical references. Design and setting: Secondary qualitative analysis of data collected from 31 semi-structured interviews. Method: Semi-structured interviews were conducted with people with T2DM in England. Data analysis was informed by constant comparative techniques. Results: People with T2DM undergo a cognitive process when their biography suddenly becomes interrupted. Suboptimal T2DM can bring a feeling of loss of control over one’s future, and loss of independence. What used to be perceived as ‘normal’ is now perceived as something that requires regular management, negatively impacting their daily routine and ability to carry out activities that once used to be effortless. Conclusions: Living with T2DM that is socially stigmatised can lead to poor well-being and may disturb one’s life biography. Strategies must take place to bring awareness to healthcare professionals of the impact and disruption that T2DM can have on an individual’s biography, identity and diabetes management.

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An Exploration of the Patient Lived Experience of Remission and Relapse of Type 2 Diabetes Following Bariatric Surgery

Obesity Surgery ◽

10.1007/s11695-021-05514-7 ◽

2021 ◽

Author(s):

Alexis C. Sudlow ◽

Dimitri J. Pournaras ◽

Helen Heneghan ◽

Zsolt Bodnar ◽

Carel W. le Roux ◽

...

Keyword(s):

Type 2 Diabetes ◽

Bariatric Surgery ◽

Lived Experience ◽

Patient Experience ◽

Healthcare Professionals ◽

Structured Interviews ◽

Disease Remission ◽

Obesity Stigma ◽

Self Worth

Abstract Background Bariatric surgery is the most effective treatment for patients with obesity and type 2 diabetes (T2DM), inducing profound metabolic changes associated with improvements in glycaemic control. In spite of the recognition of the physiological changes associated with bariatric surgery, what remains underappreciated is the patient experience of surgery to treat T2DM. Objectives This study explored the patient experience with regard to motivations, expectations and outcomes, including remission and relapse of diabetes. Methods An in-depth qualitative approach was adopted, encompassing semi-structured interviews with patients (n=17) living with obesity and T2DM both pre- and postsurgery. Interpretive thematic analysis identified emergent themes using a grounded approach. Results Analysis revealed a number of themes throughout the interviews which included motivations and perceived benefits of surgery, obesity stigma and its impact on self-worth as well as perceptions of remission or relapse and the implications for sense of control. Conclusions The motivation for undergoing bariatric surgery was driven by health concerns, namely T2DM and the desire to reduce the risk of developing diabetes-related complications. Patients highlighted social and self-stigmatisation associated with obesity and T2DM, leading to feelings of shame and an inability to seek support from family or healthcare professionals. Stigmatisation created a sense of failure and feeling of guilt for having T2DM. As a result, patients felt responsible for maintaining disease remission postoperatively and regarded the need for medication as a sign of treatment failure.

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The Impact of Obesity on Incidence of Type 2 Diabetes Mellitus (T2DM) among Women with Polycystic Ovary Syndrome (PCOS)

Diabetes ◽

10.2337/db18-1612-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1612-P

Author(s):

NADIRA SULTANA KAKOLY ◽

ARUL EARNEST ◽

HELENA TEEDE ◽

LISA MORAN ◽

DEBORAH LOXTON ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Ovary Syndrome ◽

The Impact

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116-LB: Evaluating the Impact of Glucommander on Improvement in Time-in-Range (TIR) in Type 2 Diabetes Using Continuous Glucose Monitoring

Diabetes ◽

10.2337/db20-116-lb ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 116-LB

Author(s):

BRUCE W. BODE ◽

JOHN G. CLARKE

Keyword(s):

Type 2 Diabetes ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Time In Range ◽

The Impact

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Model estimates of the results of diabetes patients using modern glucometers with tri-color technology for displaying test results

Medical Technologies Assessment and Choice (Медицинские технологии Оценка и выбор) ◽

10.31556/2219-0678.2019.37.3.081-089 ◽

2019 ◽

pp. 81-89

Author(s):

Larisa Dmitrievna Popovich ◽

Svetlana Valentinovna Svetlichnaya ◽

Aleksandr Alekseevich Moiseev

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Economic Benefits ◽

Test Results ◽

Self Monitoring ◽

Patients With Diabetes ◽

The Impact

Diabetes – a disease in which the effect of the treatment substantially depends on the patient. Known a study showed that the use of glucometers with the technology of three-color display of test results facilitates self-monitoring of blood sugar and leads to a decrease in glycated hemoglobin (HbAlc). Purpose of the study: to modeling the impact of using of a glucometer with a color-coded display on the clinical outcomes of diabetes mellitus and calculating, the potential economic benefits of reducing the hospitalization rate of patients with diabetes. Material and methods. Based on data from two studies (O. Schnell et al. and M. Baxter et al.) simulation of the reduction in the number of complications with the use of a glucometer with a color indication. In a study by O. Schnell et al. a decrease of HbA1c by 0.69 percent is shown when using the considered type of glucometers, which was the basis of the model. Results. In the model, the use of a glucometer with a color-coded display for type 1 diabetes led to a decrease in the total number of complications by 9.2 thousand over 5 years per a cohort of 40 thousand patients with different initial levels of HbA1c. In a cohort of 40 thousand patients with type 2 diabetes, the simulated number of prevented complications was 1.7 thousand over 5 years. When extrapolating these data to all patients with diabetes included in the federal register of diabetes mellitus (FRD), the number of prevented complications was 55.4 thousand cases for type 1 diabetes and 67.1 thousand cases for type 2 diabetes. The possible economic effect from the use of the device by all patients with a diagnosis of diabetes, which are included in the FRD, estimated at 1.5 billion rubles for a cohort of patients with type 1 diabetes and 5.3 billion rubles for patients with type 2 diabetes. Conclusion. Improving the effectiveness of self-monitoring, which is the result of the use of glucometers with color indicators, can potentially significantly reduce the incidence of complications in diabetes and thereby provide significant economic benefits to society.

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The Impact of Bariatric Surgery in Patients with Type-2 Diabetes Mellitus

Current Diabetes Reviews ◽

10.2174/157339911795843087 ◽

2011 ◽

Vol 7 (3) ◽

pp. 185-189 ◽

Cited By ~ 6

Author(s):

Richdeep S. Gill ◽

Arya M. Sharma ◽

David P. Al-Adra ◽

Daniel W. Birch ◽

Shahzeer Karmali

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Bariatric Surgery ◽

Type 2 Diabetes Mellitus ◽

The Impact

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Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001413 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001413

Author(s):

Jonathan Yap ◽

Kamalesh Anbalakan ◽

Wan Ting Tay ◽

Daniel Ting ◽

Carol Yim Cheung ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Glycemic Control ◽

Microvascular Complications ◽

Population Based ◽

Cardiovascular Outcomes ◽

Microvascular Complication ◽

The Impact ◽

Hba1c Levels

IntroductionDiabetes mellitus is a growing public health epidemic in Asia. We examined the impact of type 2 diabetes, glycemic control and microvascular complications on mortality and cardiovascular outcomes in a multiethnic population-based cohort of Asians without prior cardiovascular disease.Research design and methodsThis was a prospective population-based cohort study in Singapore comprising participants from the three major Asian ethnic groups: Chinese, Malays and Indians, with baseline examination in 2004–2011. Participants with type 1 diabetes and those with cardiovascular disease at baseline were excluded. Type 2 diabetes, Hemoglobin A1c (HbA1c) levels and presence of microvascular complications (diabetic retinopathy and nephropathy) were defined at baseline. The primary outcome was all-cause mortality and major adverse cardiovascular events (MACEs), defined as a composite of cardiovascular mortality, myocardial infarction, stroke and revascularization, collected using a national registry.ResultsA total of 8541 subjects were included, of which 1890 had type 2 diabetes at baseline. Subjects were followed for a median of 6.4 (IQR 4.8–8.8) years. Diabetes was a significant predictor of mortality (adjusted HR 1.74, 95% CI 1.45 to 2.08, p<0.001) and MACE (adjusted HR 1.64, 95% CI 1.39 to 1.93, p<0.001). In those with diabetes, higher HbA1c levels were associated with increased MACE rates (adjusted HR (per 1% increase) 1.18, 95% CI 1.11 to 1.26, p<0.001) but not mortality (p=0.115). Subjects with two microvascular complications had significantly higher mortality and MACE compared with those with only either microvascular complication (adjusted p<0.05) and no microvascular complication (adjusted p<0.05).ConclusionDiabetes is a significant predictor of mortality and cardiovascular morbidity in Asian patients without prior cardiovascular disease. Among patients with type 2 diabetes, poorer glycemic control was associated with increased MACE but not mortality rates. Greater burden of microvascular complications identified a subset of patients with poorer outcomes.

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