Containing rather than changing dangerous behaviours : attitudes and practices of professionals towards patients with type 1 diabetes and an eating disturbance

Background: Eating disturbances, particularly binge eating and abusing insulin to control weight, are reported to be common among individuals with type 1 diabetes mellitus (T1DM). Such problems are estimated to arise in up to 40% of this population when insulin manipulation is counted as a form of purging. The practices and attitudes of professionals based in diabetes clinics working with this patient group have not been investigated previously. Aims: To explore the attitudes and practices of hospital-based healthcare staff towards people with T1DM exhibiting disturbed eating or weight control. Data collection: Purposive sampling was used to recruit secondary care professionals from a range of disciplines (doctors, nurses, dieticians). Recruitment, from four UK hospitals, continued until data reached saturation. Face-to-face, qualitative interviews were conducted with participants. Interviews were taped and transcribed verbatim. Analysis: The qualitative data collected were analysed using a framework approach. Framework analysis is a systematic technique that involves charting and sifting of data in a methodical manner to develop themes. All members of the research team were involved in this stage of the study. Findings: Interviewees (n=20) identified many issues contributing to their difficulty in assisting individuals with disturbed eating or weight control, which stemmed from uncertainty about what should be considered a problem and from their limited training in this area. Participants were reluctant to confront patients they suspected of such behaviours, fearing they would stop attending clinic appointments and because of a paucity of follow-up services. Practitioners interviewed tried to make patients as safe as possible until they saw a psychologist or had ‘outgrown’ their eating disturbance