“I Did Not Believe You Could Get Better”—Reversal of Diabetes Risk Through Dietary Changes in Older Persons with Prediabetes in Region Stockholm
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting
2.2. Study Design and Participant Selection
- Impaired Glucose Tolerance (IGT) on OGTT (fasting plasma glucose < 7.0 mmol/L and 2 h plasma glucose > 7.8 and < 11.1 mmol/L) AND HbA1c > 42 mmol/mol
- Impaired Fasting Glucose (IFG) on OGTT [fasting plasma glucose > 6.1 and < 6.9 mmol/L and 2 h plasma glucose < 7.8 mmol/L, if measured] AND HbA1c > 42 mmol/mol
- Newly diagnosed diabetes (fasting plasma glucose > 7.0 mmol/L or 2 h plasma glucose > 11.1 mmol/L) without prior diagnosis of T2D or treatment with any anti-diabetic medication in the intervening period.
2.3. Data Collection and Analysis
3. Results
3.1. T2D Risk is Not Urgent Enough to Act Upon
- “I think I would worry if I felt symptoms, this with bad blood circulation and sensations in the feet… Impaired vision. Or something like that, but I don’t have these warning signs”. (ID: 6)
- “At first, I thought: Yes, but oh what a relief that I didn’t have it [diabetes] then. Then it wasn’t really a risk anyway. Because you don’t know. You can go and carry on something you don’t know about”. (ID: 1)
- “For me, it [the risk of diabetes] is not so bad. The fear is when they say that you have a tumor, malignant.” (ID: 2)
- “I was a little unsure of what I was told … I interpreted the answer of elevated values as it could mean normal, because it wasn’t a diagnosis. And it made me unsure about the answer. So, I did not dare to interpret it as anything else than that I remained at risk as before, because I didn’t believe you could get better. That you remain where you are. So that’s my interpretation.” (ID: 10)
- “Because if you have four values or five test results [different types of blood tests]. If one of them says that you have prediabetes, then I do not have it in my world, because there are the four other values.” (ID: 5)
3.2. Adaptations in Everyday Life as a Part of Aging
- … “We have changed diet. (…) Yes and then I’ve been to the hospital when my husband … and I demanded that we needed a nutritionist.” (ID: 7)
- “But then when I’m away, I don’t know what sort of eating monster that (laughing) that I am... but I’m trying to stay away from it.” (ID: 7)
- -
- “If you received information now that you are at risk, how do you think you would…?”
- -
- Then I would go to the doctor and let him decide.
- -
- But if he tells you: You are at risk?
- -
- Then he can tell me what to do.” (ID: 12)
3.3. Diagnosis as a Motive for Change
- “Yes, but it is when I have been diagnosed that I’m grasping it. That’s when I kind of have to put in the effort.” (ID: 8)
- “No, because I know that if I develop diabetes, it is possible to live a good life anyway. And at the same time when you come to that situation, perhaps you can think of keeping sugar values down more. To walk or move and then kind of eat up your own sugar, or not consume wrong foods.” (ID: 9)
- “Yes, prediabetes feels calmer, but diabetes is more regulated, more on track and with insulin and so, more control throughout the day. So, it’s more structured. More locked. So, you should avoid getting there.” (ID: 7)
- “Then I thought: Now I will change this totally. Now I will turn this and see if it helps. Then I started quite hard with a lot of vegetables and skipped all the grease. And after some time, I went for new tests, and they showed them to me, and there was nothing.” (ID: 8)
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Participant ID | Sex | Age | Education Level | Household Status | Medical Status Reported by SDPP in 2014–2017 |
---|---|---|---|---|---|
1 | Female | 68 | Secondary/upper secondary school | Lives together with partner | Reversed T2D risk |
2 | Female | 70 | College/University | Lives alone | Reversed T2D risk |
3 | Male | 72 | Secondary/upper secondary school | Lives together with partner | Reversed T2D risk |
4 | Male | 70 | Secondary/upper secondary school | Lives alone | Progression of T2D risk |
5 | Male | 71 | College/University | Lives together with partner | Progression of T2D risk |
6 | Male | 71 | Secondary/upper secondary school | Lives together with partner | Progression of T2D risk |
7 | Female | 67 | College/University | Lives together with partner | Reversed T2D risk |
8 | Female | 71 | Secondary/upper secondary school | Lives together with partner | Progression of T2D risk |
9 | Female | 68 | Secondary/upper secondary school | Lives together with partner | Progression of T2D risk |
10 | Male | 58 | College/University | Lives together with partner | Reversed T2D risk |
11 | Male | 70 | Secondary/upper secondary school | Lives alone | Reversed T2D risk |
12 | Male | 72 | Secondary/upper secondary school | Lives together with partner | Reversed T2D risk |
13 | Female | 71 | Secondary/upper secondary school | Lives alone | Reversed T2D risk |
14 | Female | 73 | Secondary/upper secondary school | Lives together with partner | Reversed T2D risk |
15 | Male | 72 | College/University | Lives alone | Reversed T2D risk |
Theme | T2D Risk is not Perceived as Concrete Enough to Motivate Lifestyle Modification without Other External Triggers | |||||||
---|---|---|---|---|---|---|---|---|
Category | T2D Risk is not Urgent Enough to Change Behavior | Adaptations in Everyday Life as a Part of Aging | Diagnosis as a Motive for Change | |||||
Sub category | T2D is perceived as intangible | Difficult to understand what T2D risk means | Information is not enough to produce change | Common habits change together with others | Lifestyle modification trade offs | Responsibility of medical authority | T2D diagnosis as a reason to change habits | Other diagnosis than T2D as motive for change |
Code | Risk is not concrete Prediabetes is not a real diagnosis Risk is invisible Absence of disease No fear of prediabetes | Uncertainty about what risk means Increased risk is normal Uncertainty about meaning of numbers Numbers as a tool for understanding risk information Risk is an abstract concept | Repetition is not useful Awareness of risk Obvious things Information is wanted but creates uncertainty Common sense | Eating as social activity Familiar preferences Shared responsibility Control for partner’s health Support each other | Weight reduction Aging Indulge oneself Pain Social events Willingness to replace diet Changes over time | Trust in healthcare Continuity in care Experts’ help Others positive experiences Believe in the doctors’ capacity Advice | Proof of having disease Medication Numbers make T2D visible Strict Fear of insulin injections Regulation | Disease is structured Diagnose Control Changes in diet is needed Changed level of physical activity because of diagnosis Partner’s diagnosis |
Participant ID | Recruitment Status | Perception of Risk at the First Follow up 2004–2005 | Lifestyle Modifications between First and Second Follow up | Perception of Risk at the Second Follow up 2014–2017 |
---|---|---|---|---|
1 | Reversed T2D risk | Yes, at risk | Active lifestyle changes because of T2D risk and weight reduction | Reversed T2D risk |
2 | Reversed T2D risk | Yes, at risk | Dietary changes because of stomach problems | Reversed T2D risk |
3 | Reversed T2D risk | No, not at risk “It was ok” | No active lifestyle changes | Do not know |
4 | Progression of T2D risk | No, not at risk “I interpreted it as it was good” | No active lifestyle changes | Increased T2D risk |
5 | Progression of T2D risk | No, not at risk “No, I haven’t received a response” | No active lifestyle changes because of T2D risk. Eats healthy and is physically active | No change |
6 | Progression of T2D risk | Yes, at risk | No active lifestyle changes | Increased T2D risk, but “Nothing alarming” |
7 | Reversed T2D risk | Yes, at risk | Active lifestyle changes because of T2D risk | Reversed T2D risk |
8 | Progression of T2D risk | Yes, at risk | No active lifestyle changes 10 years back, but active lifestyle changes after information from the last follow up | Increased T2D risk (interpreted as diabetic values) |
9 | Progression of T2D risk | Yes, at risk | No active lifestyle changes | Increased T2D risk |
10 | Reversed T2D risk | Yes, at risk | Dietary changes because of stomach problems | No change |
11 | Reversed T2D risk | No, not at risk “Not at a particular risk” | Dietary changes because partner’s change in choices of food | No change |
12 | Reversed T2D risk | No, not at risk | No active lifestyle changes | Reversed T2D risk |
13 | Reversed T2D risk | Yes, at risk | Dietary changes because of stomach problems | Reversed T2D risk |
14 | Reversed T2D risk | No, not at risk “But maybe I have always had a little risk” | Dietary changes to reduce weight | Increased T2D risk |
15 | Reversed T2D risk | Yes, at risk | Active lifestyle changes because of T2D risk | Reversed T2D risk |
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Share and Cite
Timm, L.; Daivadanam, M.; Lager, A.; Forsberg, B.; Östenson, C.-G.; Mölsted Alvesson, H. “I Did Not Believe You Could Get Better”—Reversal of Diabetes Risk Through Dietary Changes in Older Persons with Prediabetes in Region Stockholm. Nutrients 2019, 11, 2658. https://doi.org/10.3390/nu11112658
Timm L, Daivadanam M, Lager A, Forsberg B, Östenson C-G, Mölsted Alvesson H. “I Did Not Believe You Could Get Better”—Reversal of Diabetes Risk Through Dietary Changes in Older Persons with Prediabetes in Region Stockholm. Nutrients. 2019; 11(11):2658. https://doi.org/10.3390/nu11112658
Chicago/Turabian StyleTimm, Linda, Meena Daivadanam, Anton Lager, Birger Forsberg, Claes-Göran Östenson, and Helle Mölsted Alvesson. 2019. "“I Did Not Believe You Could Get Better”—Reversal of Diabetes Risk Through Dietary Changes in Older Persons with Prediabetes in Region Stockholm" Nutrients 11, no. 11: 2658. https://doi.org/10.3390/nu11112658