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Lawton J, Rankin D, Scott E, Lorencatto F, Gericke C, Heller SR, de Zoysa N. From educator to facilitator: Healthcare professionals' experiences of, and views about, delivering a type 1 diabetes structured education programme (DAFNEplus ) informed by behavioural science. Diabet Med 2024; 41:e15375. [PMID: 38837475 DOI: 10.1111/dme.15375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
AIMS The DAFNEplus programme incorporates behaviour change techniques into a modified educational intervention and was developed to help address the glycaemic drift observed amongst graduates of standard DAFNE programmes. As the programme's success will be contingent on staff buy-in, we explored healthcare professionals' experiences of, and views about, delivering DAFNEplus during a clinical trial to help inform decision making about rollout post-trial. METHODS We interviewed n = 18 nurses and dieticians who delivered DAFNEplus during the trial. Data were analysed thematically. RESULTS While many shared initial reservations, all described how their experiences of DAFNEplus programme delivery had had a positive, transformative impact upon their perceptions and working practices. This transformation was enabled by initial training and supervision sessions, the confidence gained from using scripts to support novel programme content delivery, and experiences of delivering the programme and observing DAFNEplus principles being well received by, and having a positive impact on, attendees. Due to these positive experiences, interviewees described a strongly felt ethical mandate to use some DAFNEplus techniques and curriculum content in routine clinical care. While being supportive of a national rollout, they anticipated a variety of attitudinal and logistical (e.g. workload) challenges. CONCLUSIONS This study provides a vital dimension to the evaluation of the DAFNEplus programme. Interviewees found the intervention to be acceptable and expressed high levels of buy-in. As well as offering potential endorsement for a national rollout, our findings offer insights which could help inform development and rollout of future behaviour change interventions to support diabetes self-management.
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Affiliation(s)
- Julia Lawton
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, UK
| | - David Rankin
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, UK
| | - Elaine Scott
- SCHARR, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | | | - Chiara Gericke
- Centre for Behaviour Change, University College London, London, UK
| | - Simon R Heller
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
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Due-Christensen M, Joensen LE, Sarre S, Romanczuk E, Wad JL, Forde R, Robert G, Willaing I, Forbes A. A co-design study to develop supportive interventions to improve psychological and social adaptation among adults with new-onset type 1 diabetes in Denmark and the UK. BMJ Open 2021; 11:e051430. [PMID: 34728449 PMCID: PMC8565545 DOI: 10.1136/bmjopen-2021-051430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To develop supportive interventions for adults with new-onset type 1 diabetes (T1D) to facilitate positive adaptive strategies during their transition into a life with diabetes. DESIGN The study used a co-design approach informed by Design Thinking to stimulate participants' reflections on their experiences of current care and generate ideas for new supportive interventions. Visual illustrations were used to depict support needs and challenges. Initial discussions of these needs and challenges were facilitated by researchers and people with diabetes in workshops. Data comprising transcribed audio recordings of the workshop discussions and materials generated during the workshops were analysed thematically. SETTINGS Specialised diabetes centres in Denmark and the United Kingdom. PARTICIPANTS Adults with new-onset T1D (n=24) and healthcare professionals (HCPs) (n=56) participated in six parallel workshops followed by four joint workshops with adults (n=29) and HCPs (n=24) together. RESULTS The common solution prioritised by both adults with new-onset T1D and HCP participants was the development of an integrated model of care addressing the psychological and social elements of the diagnosis, alongside information on diabetes self-management. Participants also indicated a need to develop the organisation, provision and content of care, along with the skills HCPs need to optimally deliver that care. The co-designed interventions included three visual conversation tools that could be used flexibly in the care of adults with new-onset T1D to support physical, psychological and social adaptation to T1D. CONCLUSION This co-design study has identified the care priorities for adults who develop T1D, along with some practical conversational tools that may help guide HCPs in attending to the disruptive experience of the diagnosis and support adults in adjusting into a life with diabetes.
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Affiliation(s)
- Mette Due-Christensen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Lene Eide Joensen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Sophie Sarre
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Ewa Romanczuk
- Steno Diabetes Center Odense, Odense Universitetshospital, Odense, Denmark
| | - Julie Lindberg Wad
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Rita Forde
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Ingrid Willaing
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Wang W, Pei X, Zhang L, Chen Z, Lin D, Duan X, Fan J, Pan Q, Guo L. Application of new international classification of adult-onset diabetes in Chinese inpatients with diabetes mellitus. Diabetes Metab Res Rev 2021; 37:e3427. [PMID: 33275827 DOI: 10.1002/dmrr.3427] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/21/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND To determine whether the new international cluster-based classification method can be applied to Chinese inpatients with diabetes mellitus (DM). METHODS Adult patients with DM hospitalized in our tertiary care centre from January 2017 to December 2018 were included in the study. K-means cluster analysis was done in clusters based on glutamic acid decarboxylase antibodies, body mass index, glycosylated haemoglobin, homeostasis model-assessed beta cell function, insulin resistance index, and age at diagnosis of DM. Chi-square test was used to analyse inter-subgroup differences in DM-related complications and family history of DM. p < 0.05 was considered significant. RESULTS A total of 1152 inpatients with DM were included in the study. Five subgroups were obtained by cluster analysis with highest proportion of population in mild obesity-related DM subgroup (34.55%), followed by mild age-related DM (21.55%), severe insulin deficiency DM (20.51%), severe insulin resistance DM (19.02%), and severe autoimmune DM subgroup (4.36%). The prevalence of diabetic retinopathy, diabetic peripheral vascular disease, diabetic ketosis, coronary heart disease, hypertension, and family history of DM differed significantly among the subgroups (p < 0.05 for all). CONCLUSIONS This cluster-based classification could be applied to hospitalized adult patients with DM in China. It might help in strategizing for DM patients, and hence, improve management of DM in these patients.
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Affiliation(s)
- Weihao Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Xiaobei Pei
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Lina Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Zhi Chen
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Dong Lin
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Xiaoye Duan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Jingwen Fan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
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Due-Christensen M, Willaing I, Ismail K, Forbes A. Learning about Type 1 diabetes and learning to live with it when diagnosed in adulthood: two distinct but inter-related psychological processes of adaptation A qualitative longitudinal study. Diabet Med 2019; 36:742-752. [PMID: 30329176 DOI: 10.1111/dme.13838] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2018] [Indexed: 11/27/2022]
Abstract
AIM To explore the experiences of adults with newly diagnosed Type 1 diabetes in order to understand the adaptive processes that occur in the early phase of the condition. METHODS We conducted longitudinal semi-structured interviews with 30 adults newly diagnosed with Type 1 diabetes (age range 20-67 years; 16 men; median diabetes duration 23.5 months), recruited from hospitals in Denmark and the UK. The data were analysed using a narrative approach. RESULTS The narratives could be grouped into three thematic areas: the diagnosis; learning about diabetes; and learning to live with diabetes. Diabetes was characterized as a major disruptor to the established and future life plans of participants, causing significant emotional distress. The narratives showed how early experiences triggered the development of ongoing psychological problems (fear of complications or hypoglycaemia) and diabetes distress, and that navigating different social scenarios (relationships and employment) could be challenging, leading to suboptimal self-management behaviours. The narratives also showed that health professionals often did not attend effectively to participants' emotional needs after diagnosis, and that the language used frequently triggered negative feelings, such as fear or a sense of failure. CONCLUSIONS Many of the common psychosocial problems associated with Type 1 diabetes seem to gestate in the early phase of life with the condition. There appear to be opportunities to enhance the support provided in this phase to minimize these problems.
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Affiliation(s)
- M Due-Christensen
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - I Willaing
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - K Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - A Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Fritsche A, Anderten H, Pfohl M, Pscherer S, Borck A, Pegelow K, Bramlage P, Seufert J. HbA1c target achievement in the elderly: results of the Titration and Optimization trial for initiation of insulin glargine 100 U/mL in patients with type 2 diabetes poorly controlled on oral antidiabetic drugs. BMJ Open Diabetes Res Care 2019; 7:e000668. [PMID: 31423316 PMCID: PMC6688703 DOI: 10.1136/bmjdrc-2019-000668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/19/2019] [Accepted: 07/02/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To identify real-world, age-related trends in the use of insulin glargine 100 U/mL (Gla-100) as part of basal-supported oral therapy (BOT). RESEARCH DESIGN AND METHODS The prospective, observational Titration and Optimization registry enrolled patients with poorly controlled type 2 diabetes mellitus initiated on Gla-100 BOT. The primary outcome was the proportion of patients with capillary fasting blood glucose (FBG) ≤110 mg/dL on ≥2 occasions and/or who met their individual HbA1c target within 12 months. RESULTS 2462 patients were analyzed (<65 years: n=1122; 65-74 years: n=771; ≥75 years: n=569). Diabetes duration (6.8, 8.9, and 11.2 years, p<0.0001) and proportion of women (40.7%, 47.9%, and 55.7%, p<0.0001) increased with age. Baseline HbA1c was highest in <65-year-olds (8.6% vs 8.4% and 8.5%, p<0.0001). Gla-100 up-titration until 12 months was highest in <65-year-olds (+11.6 U/day), compared with 65-74 (+10.2 U/day) and ≥75 years (+8.8; p<0.0001) but similar by units per kilogram, as was the decrease in FBG (<65: -64.1 mg/dL; 65-74: -56.1 mg/dL; ≥75: -53.4 mg/dL) and HbA1c (<65: -1.47%; 65-74: -1.31%; ≥75: -1.22%, p<0.0001). At 12 months, 65.9% of participants met the primary endpoint, with no significant difference between age groups. The proportion achieving their individual HbA1c target was lower for <65-year-olds (46.0% vs 54.3% and 54.7%; p<0.02). Symptomatic hypoglycemia incidence was more common in the ≥75-year-old group (3.4% vs 1.4% and 1.4%; p=0.0126). CONCLUSIONS BOT with Gla-100 results in similar improvements of glycemic values with low risk of hypoglycemia across age groups. Given the link between HbA1c and long-term cardiovascular risk, ensuring appropriately stringent target-setting, intensification of basal insulin and making sure hypoglycemia is avoided is of paramount importance. TRIAL REGISTRATION NUMBER Database: https://awbdb.bfarm.de; Identifier: 1641; Date of registration: September 23, 2013.
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Affiliation(s)
| | - Helmut Anderten
- Gemeinschaftspraxis Anderten-Krok & Partner, Hildesheim, Germany
| | - Martin Pfohl
- Medizinische Klinik I, Evang. Krankenhaus Bethesda gGmbH, Duisburg, Germany
| | - Stefan Pscherer
- Klinik für Innere Medizin III, Sophien- undHufeland-Klinikum, Weimar, Germany
| | - Anja Borck
- Sanofi-Aventis Deutschland GmbH, Berlin, Germany
| | | | - Peter Bramlage
- Institut für Pharmakologie und Präventive Medizin, Cloppenburg, Germany
| | - J Seufert
- Abteilung Endokrinologie und Diabetologie, Klinik für Innere Medizin II, Medizinische Fakultät, Albert-Ludwig-Universität Freiburg, Freiburg, Germany
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Campbell F, Lawton J, Rankin D, Clowes M, Coates E, Heller S, de Zoysa N, Elliott J, Breckenridge JP. Follow-Up Support for Effective type 1 Diabetes self-management (The FUSED Model): A systematic review and meta-ethnography of the barriers, facilitators and recommendations for sustaining self-management skills after attending a structured education programme. BMC Health Serv Res 2018; 18:898. [PMID: 30482202 PMCID: PMC6258400 DOI: 10.1186/s12913-018-3655-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 10/26/2018] [Indexed: 11/23/2022] Open
Abstract
Background People with type 1 diabetes who attend structured education training in self-management using flexible intensive therapy achieve improved blood glucose control and experience fewer episodes of severe hypoglycaemia. However, many struggle to sustain these improvements over time. To inform the design of more effective follow-up support we undertook a review of qualitative studies which have identified factors that influence and inform participants’ self-management behaviours after attending structured education and their need for support to sustain improvements in glycaemic control. Methods We undertook a meta-ethnography of relevant qualitative studies, identified using systematic search methods. Studies were included which focused on participants’ experiences of self-managing type 1 diabetes after attending structured education which incorporated training in flexible intensive insulin therapy. A line of argument approach was used to synthesise the findings. Results The search identified 18 papers from six studies. The studies included were judged to be of high methodological quality. The line of argument synthesis developed the Follow-Up Support for Effective type 1 Diabetes self-management (FUSED) model. This model outlines the challenges participants encounter in maintaining diabetes self-management practices after attending structured education, and describes how participants try to address these barriers by adapting, simplifying or personalising the self-management approaches they have learned. To help participants maintain the skills taught during courses, the FUSED model presents ten recommendations abstracted from the included papers to provide a logic model for a programme of individualised and responsive follow-up support. Conclusions This meta-ethnography highlights how providing skills training using structured education to people with type 1 diabetes does not necessarily result in participants adopting and sustaining recommended changes in behaviour. To help people sustain diabetes self-management skills after attending structured education, it is recommended that support be provided over the longer-term by appropriately trained healthcare professionals which is responsive to individuals’ needs. Although developed to inform support for people with type 1 diabetes, the FUSED model provides a framework that could also be applied to support individuals with other long term conditions which require complex self-management skills to be learned and sustained over time. Trial registration PROSPERO registration: CRD42017067961. Electronic supplementary material The online version of this article (10.1186/s12913-018-3655-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fiona Campbell
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, S1 4DA, Sheffield, England.
| | - Julia Lawton
- The Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School of Molecular, Genetic and Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
| | - David Rankin
- The Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School of Molecular, Genetic and Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
| | - Mark Clowes
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, S1 4DA, Sheffield, England
| | - Elizabeth Coates
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, S1 4DA, Sheffield, England
| | - Simon Heller
- Sheffield University School of Medicine, Academic Unit of Diabetes, Endocrinology, and Metabolism, School of Medicine and Biomedical Sciences, Sheffield, UK
| | - Nicole de Zoysa
- Diabetes Centre, King's College Hospital, Denmark Hill, London, SE5 9RS, England
| | - Jackie Elliott
- Sheffield University School of Medicine, Academic Unit of Diabetes, Endocrinology, and Metabolism, School of Medicine and Biomedical Sciences, Sheffield, UK
| | - Jenna P Breckenridge
- School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, Scotland
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Entwistle VA, Cribb A, Owens J. Why Health and Social Care Support for People with Long-Term Conditions Should be Oriented Towards Enabling Them to Live Well. HEALTH CARE ANALYSIS 2018; 26:48-65. [PMID: 27896539 PMCID: PMC5816130 DOI: 10.1007/s10728-016-0335-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When (the promotion of) support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for disease control, it implicitly reflects and perpetuates limited and somewhat instrumental views of patients. It tends to: restrict the pursuit of respectful and enabling ‘partnership working’; run the risk of undermining patients’ self-evaluative attitudes (and then of failing to notice that as harmful); limit recognition of the supportive value of clinician-patient relationships; and obscure the practical and ethical tensions that clinicians face in the delivery of support for self-management. We suggest that a focus on enabling people to live (and die) well with their long-term conditions is a promising starting point for a more adequate conception of support for self-management. We then outline the theoretical advantages that a capabilities approach to thinking about living well can bring to the development of an account of support for self-management, explaining, for example, how it can accommodate the range of what matters to people (both generally and more specifically) for living well, help keep the importance of disease control in perspective, recognize social influences on people’s values, behaviours and wellbeing, and illuminate more of the rich potential and practical and ethical challenges of supporting self-management in practice.
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Affiliation(s)
- Vikki A Entwistle
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK.
| | - Alan Cribb
- School of Education, Communication and Society, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London, SE1 9NH, UK
| | - John Owens
- School of Education, Communication and Society, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London, SE1 9NH, UK
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Abstract
Background: Diabetes ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions. Methods: A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families. A before-after study was conducted comparing performance outcomes in years 2007-2010 (preintervention) to 2012-2014 (postintervention) using administrative data and Wilcoxon rank sum and Fischer exact tests. Results: DKA admissions decreased by 44% postintervention (16.7 vs 9.3 per 100 followed patient-years; P = .006), unique patient 30-day readmissions decreased from 20% to 5% postintervention (P = .001), and median LOS significantly decreased postintervention (P < .0001). Although not an original goal of the study, median hemoglobin A1C of a subset of the population transitioned from sliding scale decreased, 10.3% to 8.9% (P < .02). Conclusions: When clinical and widespread program interventions were used, significant reductions in DKA hospitalizations, 30-day readmissions, and LOS occurred for pediatric T1DM. Continuous performance improvement efforts are needed for improving DKA outcomes.
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Due-Christensen M, Zoffmann V, Willaing I, Hopkins D, Forbes A. The Process of Adaptation Following a New Diagnosis of Type 1 Diabetes in Adulthood: A Meta-Synthesis. QUALITATIVE HEALTH RESEARCH 2018; 28:245-258. [PMID: 29235942 DOI: 10.1177/1049732317745100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
While Type 1 diabetes (T1D) is generally associated with childhood, half of all cases occur in adulthood. The adaptive strategies individuals employ during the initial adaptive phase may have an important impact on their risk of future diabetes complications and their psychosocial well-being. We conducted a systematic review of six databases and included nine qualitative studies in a meta-synthesis, the aims of which were to develop a better understanding of how adults newly diagnosed with T1D experience the diagnosis and the phenomena associated with the early process of adaptation to life with diabetes. The meta-synthesis identified five constructs that shaped and influenced the early adaptive process: disruption, constructing a personal view of diabetes, reconstructing a view of self, learning to live with diabetes, and behavioral adaptations. The adaptive processes of adults to a diabetes diagnosis are highly referenced to prior life experiences, social habitus, and psychological orientation.
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Affiliation(s)
| | - Vibeke Zoffmann
- 2 Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - David Hopkins
- 4 King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
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