Abstract
Background: Diabetes mellitus is a chronic metabolic disease of which there are many types: most namely type 1 diabetes (T1DM), an autoimmune disease resulting in an absolute insulin deficiency; and type 2 diabetes (T2DM), a disease with a complex heterogenous pathogenesis that results in a relative insulin deficiency. Maintaining long-term glycaemic control is a hallmark of treatment in both of these conditions and oftentimes requires intense and frequent self-monitoring of blood glucose (SMBG), primarily using capillary blood glucose testing. There is limited research that provides insight into the lived experiences of individuals with these conditions, and how diabetes can interfere with their daily functioning. Thus, further research is required to provide experiential evidence to inform future clinical practice and research.
Aim: The broad aim of this thesis is to explore the lived experiences of individuals with diabetes, using qualitative methodology, focused on the two key topics of alcohol consumption in young adults with T1DM, and the impact of initiating real-time continuous glucose monitoring technology use in adults with T2DM.
Methods: This thesis contains two studies using a general inductive semi-structured qualitative interview methodology. Following each qualitative study, the interviews were transcribed verbatim from audio recordings and thematically analysed to reveal any relevant themes. Study 1 included 12 adults with type 2 diabetes using insulin for daily management. Participants were asked about their experiences using recently commenced real-time continuous glucose monitoring technology to manage their diabetes. Topics covered in this interview included the benefits and negatives of using such technology, as well the overall impact on their health, management, and well-being. Study 2 included 14 young adults with type 1 diabetes. Interviews included topics related to their understanding and management of their condition whilst consuming alcohol, with specific discussion related to the impact of alcohol on their glycaemic control and safety, the frequency of social occasions where alcohol was consumed, and amount and type of alcohol consumed whilst drinking, and their behaviours related to glucose management whilst drinking.
Results: In study 1 the interviews in adults with type 2 diabetes new to rt-cgm revealed 3 key themes: i) rtCGM as a facilitator of improved health behaviours; ii) the acceptability of rtCGM systems compared to capillary blood glucose testing; and iii) barriers to the continual usage of rtCGM technology including connection difficulties, longevity of the sensors, and local cutaneous reactions to the sensor adhesive. In study 2, the interviews confirmed that young adults with type 1 diabetes engage in social, and occasionally excessive drinking behaviour. The interviews also revealed four key themes: i) Several sources contribute to a widely inconsistent understanding of the impact and management of alcohol consumption; ii) Perceived inconvenience of maintaining healthy glycaemic control whilst drinking socially; iii) Engagement in proactive strategies for harm reduction occurred when convenient; and iv) Impact of modern diabetes technology in overcoming previous burdens and promoting glycaemic safety.
Conclusion: Glycaemic control can be difficult to control for individuals with diabetes, and the burdens of maintaining such control can result in poorer engagement with an individual’s health. Individuals within both studies of this thesis reported experiences of harm, chronic and acute in Study 1 and Study 2 respectively, related to sub-optimal glycaemic control originating from the complexities of adherence to their management regimen. Diabetes technologies offer one potential mechanism whereby this burden of care can be alleviated and therefore harm can be reduced.