On the borderline of diabetes: understanding how individuals resist and reframe diabetes risk

Facilitators and barriers for lifestyle change in people with prediabetes: a meta-synthesis of qualitative studies

“…Participants attended 23 group-based classes over one year. The participants were interviewed at six (n = 13) and 12 months ( n = 12) Area for lifestyle change (intervention): To promote dietary changes Howells et al, 2021, England [ 52 ] Exploring how individuals with prediabetes understand biomedical definitions of risk and the extent to which they resist them, as this reframing of risk could have implications for engagement with the NHS DPP High-risk patients defined as prediabetic via a blood glucose test (HbA1c level 42–47 mmol/mol) and who had received their prediabetes diagnosis within the last 12 months n = 43* F = 20 M = 23 Mean age: 60 *Seven general practices were purposively selected to recruit participants (based on a range of factors, including deprivation scores, ethnic diversity and their approach to informing their patients about diabetes risk). From these, all eligible at-risk patients were invited to have consultations audio-recorded and to also participate in in-depth interviews Qualitative mixed methods: observational study (audio recorded consultations), and individual in-depth interviews Grounded theory approach Not described Setting: In the context of a national diabetes prevention program, the setting of this study is the primary care consultation where data was drawn from individual interviews and observations Area for lifestyle change (no intervention): To promote exercise and dietary changes Wallace et al, 2021, USA [ 53 ] Understanding how Latinos with prediabetes attempted to slow T2D progression and how stress affected their engagement in these behaviours (1) 20 years of age or older; (2) born in a Spanish-speaking Latin American or Caribbean country; 3) doctor confirmed prediabetes diagnosis (haemoglobin A1c range 5.7–6.4%) or elevated fasting glucose reading 100–125 mg/dL in past year, and (4) received medical care in the health system in the past year n = 20 F = 14 M = 6 Age range: 22–72 Mean age: 51 Qualitative semi-structured interviews Not described Setting: Participants were interviewed after having been diagnosed with prediabetes, following participants’ medical appointments Area for lifestyle change (intervention): To promote exercise and dietary changes * How participants in the qualitative data collection were selected if part of a larger study IFG Impaired fasting glucose, IGT Impaired glucose tolerance, FPG Fasting plasma glucose, FBG Fasting blood glucose, OGTT Oral glucose tolerance test, BMI Body mass index, T2D Type 2 diabetes and DPP Diabetes prevention program F Female, M Male …”

‘Finishing the race’ – a cohort study of weight and blood glucose change among the first 36,000 patients in a large-scale diabetes prevention programme

“…The target population was adults aged 18 and over with non-diabetic hyperglycaemia (NDH), defined as glycated haemoglobin (HbA1c) of 42–47 mmol/mol (6·0–6·4%) or fasting plasma glucose level (FPG) of 5·5–6·9 mmol/l. Participants were referred to the programme through their GP via one of two main routes: i) referral by a primary care professional following a consultation, or ii) self-referral following receipt of a letter from their GP, informing them of their high risk of type 2 diabetes (based on their medical records) and encouraging them to participate [ 12 ]. Delivery was provided by four independent service providers commissioned locally in each site – generally defined at Sustainability and Transformation Partnership (STP) level [ 13 ].…”

Revisiting Candidacy: What Might It Offer Cancer Prevention?

“…Along with other research regarding CHD prevention [ 84 , 85 , 86 ], issues including suicide prevention [ 46 , 47 ], diabetes [ 87 ] and COVID-19 [ 51 ], have also been examined through a candidacy lens, offering extensions to the initial candidacy system devised by Davison, and these will now be considered.…”

“…I’m a healthy eater and we walk a lot. I’ve always exercised’ [ 87 ] (p. 43). In this way, individuals’ distance themselves from the stereotype of a diabetic candidate (unhealthy or obese) and are able to exclude their own candidacy based on this.…”

“…Competing candidacy is also apparent, where other issues override the ability to accept or focus on candidacy. The need for individuals to prioritise other roles and responsibilities, prioritise other health issues or choose not to change associated lifestyle behaviours (should they accept their candidacy) [ 87 ], all provide examples of reasons for competing candidacy.…”