For people experiencing the early warning signs of Type 2 Diabetes, being told about the potential risks of the condition can do little to encourage a change in lifestyle due to social and cultural factors, according to research from a team at Oxford University reporting in BMC Medicine.
Diabetes is on the rise nationally with 4 million people being affected by the condition in the UK. The total cost of treating diabetes and its complications is estimated to be £23.7billon, currently 10% of the NHS budget.
Diabetes prevention has become a national priority. Policymakers are particularly interested in targeting preventive efforts towards people with ‘pre-diabetes’ (where the level of glucose in the blood is higher than normal but not yet high enough to count as diabetic). These individuals may be able to prevent progression to full-blown diabetes by losing weight and increasing their exercise levels.
To find out how people’s behaviours change when they are given a diagnosis of ‘pre-diabetes’, the team of researchers from Oxford University’s Nuffield Department of Primary Care Health Sciences reviewed data from 15 research studies, including 11 based on interviews and focus groups.
They found that providing knowledge about the risks of pre-diabetes did not always (or even usually) lead to changes in lifestyle in people with pre-diabetes. For behaviour change, people needed to have material resources (such as being able to pay for healthy food options and gym membership), social support from friends and family, as well as successfully navigating the norms and expectations of their cultural and religious group.
Those who had multiple disadvantages such as poor housing, a low income, absent social support or conflicting cultural norms found it much harder to achieve the kind of lifestyle changes necessary to prevent diabetes.
Lead author Eleanor Barry, NIHR Doctoral Research Fellow and DPhil student, said “These findings are important because diabetes is much more common in people from low-income and minority ethnic backgrounds. The National Diabetes Prevention Programme is providing individual lifestyle education for people found to have pre-diabetes. Our findings suggest that additional work will need to be done to address the wider material and environmental influences on health, to ensure that the National Diabetes Prevention Programme achieves its goal of preventing a significant proportion of new cases of diabetes. “
The study was funded by an National Institute for Health Research In-Practice Fellowship and is part of a programme of work from the NIHR Oxford Biomedical Research Centre.
How are health-related behaviours influenced by a diagnosis of pre-diabetes? A meta-narrative review.
Eleanor Barry, Trisha Greenhalgh, Nicholas Fahy
BMC Medicine 2018. https://doi.org/10.1186/s12916-018-1107-6