Understanding the physical, social, and emotional experiences of people with uncontrolled Type 2 diabetes: a qualitative study

Anna Berenguera,1,2,* Àngels Molló-Inesta,1,3,4,* Manel Mata-Cases,1,4–6 Josep Franch-Nadal,1,2,6–8 Bonaventura Bolíbar,1 Esther Rubinat,1,9,10 Dídac Mauricio1,11 1Scientific Department, Institut Universitari d’Investigació en Atenció Primària Jordi Gol, Cerdanyola del Vallès, Spain; 2Primary Care Department, Universitat Autònoma de Barcelona, Barcelona, Spain; 3Cervera Primary Health Care Centre, Ileida, Spain; 4Diabetes Association in Primary Health Care (RedGDPS), Institut Català de la Salut, Barcelona, Spain; 5La Mina Primary Health Care Centre, Barcelona, Spain; 6CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain; 7Raval Sud Primary Health Care Centre, Barcelona, Spain; 8Primary Health Care Department, Institut Català de la Salut, Barcelona, Spain; 9Nursery Department, Univeristat de Lleida, Lleida, Spain; 10Centro de Investigacion Biomedica en Red de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; 11Endocrinology & Nutrition Department, CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Health Sciences Research Institute and Hospital Germans Trias i Pujol, Badalona, Spain *These authors contributed equally to this work Purpose: The purpose of this study was to identify the perceptions, barriers, and facilitators of self-management of Type 2 diabetes mellitus (T2DM) to determine the factors to consider when developing and implementing a person-centered intervention in patients with poor glycemic control attending primary care. Methods: This was a qualitative study conducted in 6 primary care health centers in Catalonia. Patients who had been diagnosed with T2DM and had glycated hemoglobin of 9% or more were included. The sampling method was opportunistic, accounting for gender, age, duration of diabetes, and type of treatment. Forty-three semi-structured interviews were conducted. Thematic content analysis was performed. Results: The patients perceived the diagnosis of T2DM as a threat to their health, and the diagnosis generated cognitive and emotional representations of T2DM. The emotions associated with the diagnosis included fear of the future, worry, denial, sadness, and dejection. The patients also wondered if there could have been an error in their test results because they did not present any symptoms. These representations, both cognitive and emotional, can produce specific effects in adaptation processes and require different approach strategies, specifically regarding diet, physical activity, and pharmacological treatment. Finally, specific aspects regarding the acceptability and adaptability of the implementation of a new intervention were expressed. Conclusion: Patients with T2DM and very poor glycemic control expressed difficulty achieving a balance between the needs and demands of managing and controlling T2DM because they felt it strongly interfered in their daily lives. Keywords: qualitative research, interviews as a topic, Type 2 diabetes, self-managemen