Introduction
Prediabetes can precede type two diabetes mellitus (T2DM) and is a condition where blood glucose levels are above normal, but not high enough to be classified as T2DM.1 Prediabetes is associated with a higher risk for heart disease, stroke, neuropathy, and microvascular complications.2 There is international variation in the definition of and the tests used to diagnose prediabetes and T2DM. In New Zealand (NZ), the diagnosis of prediabetes is made when a glycated haemoglobin (HbA1c) level is between 41 and 49 mmol/mol; and T2DM when a HbA1c level is ≥50 mmol/mol.3
Prediabetes is associated with between a 5 and 10% annual conversation rate to T2DM4 and eventually a 70% conversion.5 Some people spontaneously revert to normoglycaemia.6 Prediabetes may also be reversed or stabilised by lifestyle interventions.7 Interventions that reduce the risk of conversion to T2DM or increase the rate of reversion to normoglycaemia are important, not only for individual wellbeing, but also to reduce societal disease and economic costs associated with T2DM.8
In NZ, there is a high and increasing prevalence of both prediabetes and T2DM.9 The prevalence for prediabetes is 30.4% for Māori, and 29.8% for Pacific peoples, with an overall prevalence of 26%.10 This is in parallel with the high prevalence of obesity in NZ, where about one-third of adults are obese, with obesity more prevalent in Māori and Pacific peoples.9 These ethnic differences are, in part, associated with inequitable care, including types of interventions offered and the degree to which culturally safe care is given.11
People with prediabetes in NZ are often identified during the population-wide primary care cardiovascular risk assessment programme and are then managed in primary care. Management is based on NZ Ministry of Health guidelines12,13 and regional clinical pathways,14 which advise: (1) Healthy eating; (2) Increased physical activity; (3) Weight reduction; and (4) Medication. There are no specific national NZ intensive prediabetes interventions as in other countries,7,15,16 although time-limited initiatives have been trialled.17–20
Study aim
This study reports the qualitative component of a mixed methods study, which also included a randomised controlled trial (RCT) evaluating the effect of probiotic and breakfast cereal-based prebiotic interventions in those with prediabetes.21 Ethical approval was granted by the Central Health and Disability Ethics Committee (17/CEN/88). Participants were given a prediabetes information pamphlet at enrolment. Researchers did not give health advice, nor instigate discussions around prediabetes, but clarified the understanding of prediabetes if asked. In this qualitative component, we sought to investigate views about prediabetes and its management from general practitioners (GPs) and nurses, and people with prediabetes.
Methods
Study design
A sequential mixed qualitative methods approach was used.22 Mixed methods intentionally collect multiple data sets with the aim of triangulating the data. Similarities and differences across the datasets can expand or elucidate understanding. Four data sets were collected: open-ended free-text survey responses about individuals’ understanding of pre-diabetes and the impact of diagnosis; individual interviews; focus group data from people with prediabetes; and finally focus group data from health professionals. These datasets were gathered at different times during the overall study (see Fig. 1).
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Participants and data collection
Both GPs and nurses were purposively recruited from three general practices in Wellington, New Zealand. They participated in one of three face-to-face focus groups (one per practice). Semi-structured questioning explored their views about working with people with prediabetes.
The people with prediabetes were recruited for interview/focus group participation from the RCT intervention arm. We purposively recruited equal numbers of participants from each ethnic group (Māori, Pacific and South Asian), as well as a European/other category. We sought participants with Māori, Pacific and South Asian ethnicity as these groups are disproportionally affected by T2DM and prediabetes. Learning about the experiences of groups with the highest rates of these conditions is important to understand the drivers of inequities.
The last 85 of the 153 people recruited to the RCT population were asked to complete an online survey.
Survey, individual and focus group questions were informed by previous work on lifestyle behaviour change and health service delivery,23 and included participants' views of their health and the study intervention.
Data analysis
Interviews and focus group discussions were transcribed. Each dataset was analysed independent to the others. The analysis used an inductive approach to establish meaning and themes,24 with NVivo 12 (QSR International) used to categorise and code (JH, SM, FH). A consensus of themes and analysis was obtained for each dataset through discussion and testing of examples (EM, SM, FH, CB).
Results
Table 1 shows a summary of participants and Table 2 a summary of identified themes.
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[Image omitted: See PDF] |
GPs’ and nurses’ views of prediabetes care
Uncertainty about progression
GPs believed progression to T2DM was unpredictable. This created uncertainty about when and how to intervene. Some described people with prediabetes whose raised HbA1c had stayed the same for years. Others thought progression was inevitable, irrespective of what was done.
…she had prediabetes and she didn’t want it to progress to diabetes so very early on she went on low dose Metformin … (but) your genetics get you in the end. (FG2, GP2)
Nurses felt their efforts should focus on those with higher levels of HbA1c and as a discipline, they seemed to be more optimistic that they could successfully support lifestyle change.
Yep 49 to 50 (HbA1c), I think more time needs to be spent with this group of patients because I think if we can catch them early and talk to them about lifestyle changes … the nurses hold a really important part in this process … (FG2, Nurse1)
Prediabetes is not a priority
GPs and nurses alike said prediabetes was not a priority in their work, often because it was just one condition among others that people with prediabetes had. In everyday practice, GPs and nurses struggled with fitting in the prediabetes conversation, judging when and how to raise it and what to cover.
…they’ve got the anxiety and asthma and we just throw in a wee bit of diabetes or prediabetes. In 15 minutes and that includes ‘oh hello, how’s it going, see you, bye’ and writing notes. And the script. (FG2, GP5)
Many GPs discounted actively intervening when the HbA1c had just entered the prediabetes range, saving their efforts for those about to progress to T2DM. Some did not tell people when their HbA1c was in the early 40s range, whereas others simply mentioned and minimised it.
(with prediabetes)… they’re not anywhere near the steep part of microvascular complication curve. Do you actually need to do anything more? Is this solving it, trying to address a problem that’s not there. Or do you wait till they dip a toe into diabetes and then you intervene? (FG3, GP4)
What to say and what to advise
Both GPs’ and nurses’ uncertainty about prediabetes progression resulted in them being unsure about the best way to explain prediabetes and what to emphasise. They did not want to exaggerate the relative importance of prediabetes, but also wanted people to feel sufficiently concerned so they would make lifestyle changes.
…they’ve got to want to change. Yep so you can’t give them too much information because it all just comes in it’s just overload so I don’t know what works. (FG2, Nurse1)
Explanations ranged from the low-key: ‘blood sugars are a bit higher’ (FG3, Nurse1) to the assertive: ‘if you do not make some steps or make some changes it is very, very likely that you will go on to develop diabetes’. (FG1, GP2)
Broad advice was given around making ‘lifestyle changes’ and ‘taking action’. Both GPs and nurses focused on dietary advice, such as reducing portion size and foods high in fat and sugar, while increasing plant consumption and physical activity. They believed working with Māori and Pacific peoples about diet and weight loss was particularly challenging as cultural patterns of eating were incompatible with the more constrained diet needed to avoid prediabetes.
… there are other kinds of cultural food that they want to eat for breakfast which has lots of (sugar) like it’s coco rice. (FG1, Nurse1)
Many people with prediabetes were felt to be in the pre-contemplative phase of the motivation cycle.25 Finding the right motivator might work, such as reminding them about another family member with T2DM consequences or staying healthy for the grandchildren. The uncertainty about whether GPs’ and nurses’ efforts were effective was reinforced when people cycled through changing and reverting lifestyle behaviour. As a fall-back, they ‘plugged away’ with prediabetes education, acknowledging this was an interim strategy.
…people go in bursts, they’re fine at the beginning and then it just eases off and then you know you go through the cycle again. (FG2, GP6)
Views of people with prediabetes about prediabetes and care
Uncertainties about diagnosis and information
Some people did not know they had prediabetes until invited to join this study. Several worried that they should have been informed earlier. Some were frightened by having prediabetes, but many were relatively untroubled. Others were uncertain about the importance of prediabetes and wondered about the volume and complexity of the information received or conversely that it was too vague.
… when I got told I had prediabetes … I had an appointment with the nurse. She was talking about exercise and watching your diet and that sort of thing, they’re all very vague sort of things. (FG4, 137, Asian)
Many of those who were Māori or Pacific felt certain they would develop T2DM, with some surprised they had not already developed it. This was particularly so for those with whānau (family) affected and they described health-related consequences of T2DM such as amputations, blindness and early death. A few wondered if they could stop the progression.
How long can you be prediabetic before you become diabetic or [can] you never become diabetic? (FG2, 053, NZ European)
Despite these uncertainties, most people recounted accurate information they had been told. This included the numbers in the HbA1c range, blood sugar elevation, relationship between prediabetes and T2DM, and need for lifestyle changes. They knew the reasons why they had prediabetes such as family heritage, dietary patterns, being overweight or obese and lack of physical activity. Very few described knowing nothing about prediabetes: ‘(I) don’t have a clue’. (Survey, 084, Māori).
Those who were Māori or Pacific felt the current public health messages were not effective.
Yes it’s the number one disease (T2DM)… and it’s been sort of publicised… all the marae- there’s posters up but there doesn’t seem to be a lot of change in people. (FG1, 024, Māori)
Doing something about prediabetes
People described what they should do about prediabetes and differentiated between this and what they had done.
… if you change your diet you have positive impacts on being prediabetic. But a lot of people don’t change their diet because it’s just too much effort. (FG2, 050, NZ European)
Some described intentions to change soon.
… (changing) some of my habits such as having coffee without sugar, drinking coke no sugar. (Survey, 103, NZ European)
Lifestyle change is hard
People with prediabetes discussed at length their uncertainties about lifestyle change. Many gave examples of failed attempts, often regarding weight loss.
And I was doing triathlons for a while (and) lost the weight and then I put the weight back on – … I lost 30 kilos I gained 15. (Int, 078, Māori)
Cultural mores were a strong influence, particularly for Māori and Pacific peoples. But there were also lifelong patterns of unhelpful eating, irrespective of ethnicity.
Unfortunately, I love food and our culture, yes we love food… With our culture- any big event … (if) there’s not enough food- it’s not a very good event. (Int, 029, Pacific)
Older Māori women participants actively championed change within whānau. Their efforts were not wholly well received, with seemingly light-hearted but pointed jokes expressed. Despite this, they persisted because they knew the long-term consequences.
I’m saying to them, I’m getting to them saying look you’re all over 50 now come on we’ve got to last, you’ve got a grandchild coming up so let’s do something about that, you want to be there until they’re married. (FG3, 078, Māori)
Discussion
The viewpoints of all those who participated in the study had elements of both uncertainty and certainty about prediabetes and its management.
Health professionals’ views
In general, GPs and nurses are uncertain about prediabetes. There was a lack of conviction that prediabetes interventions work. Limited time and possibly skill to implement interventions may reduce the ability of GPs and nurses to support individuals to achieve or sustain lifestyle change.26 This contrasts with approaches used in large-scale international nation-wide prediabetes initiatives where this is a dedicated activity.27,28
Prediabetes is a problematic diagnosis for many GPs, and current NZ guidelines/advice are unclear. GPs felt dissatisfied with the conversations they had about prediabetes and questioned if it was the best use of their time when other conditions were more important. They wanted tools to discern who would benefit from a more intensive approach. The lack of clear information reinforced their certainty about not acting at the lower HbA1c range or not necessarily telling people about their prediabetes diagnosis. Australia appears to have developed a more nuanced approach to prediabetes by establishing categories of those with prediabetes who are most at risk and targeting them for higher intensity interventions.29
Nurses, in contrast to GPs, wanted people with prediabetes to have lifestyle counselling. Nurses were keener to do this work than GPs, and seemed more optimistic they could make a difference. Overseas and NZ studies have found the nursing skill set is a good match for prediabetes lifestyle counselling.30,31 Coppell et al. report a NZ primary care nurse-led prediabetes brief intervention, which resulted in those in the intervention group successfully losing weight.18 The participants made dietary changes32,33 in relation to goals set and the intervention was cost-effective.34
GPs and nurses did not routinely advise people with prediabetes about weight loss, hinting that it would not be well received. Other NZ research on weight-loss conversations found GPs frame weight loss as ‘healthy eating’.35 Some GPs and nurses explicitly acknowledged the more restrained forms of eating advised for those with prediabetes contravened the cultural norms of manaakitanga and hospitality held by Māori, Pacific and other ethnicities. More work is needed to find culturally relevant ways to modify food practices, as well as using findings from research already undertaken,19,36–38 and from this, upskilling GPs and nurses with culturally sensitive nutrition education. There also needs to be a greater range of disciplines involved such as dietitians (particularly Māori and Pacific dietitians).
People with prediabetes views
People with prediabetes were generally knowledgeable about the condition, and this may simultaneously reflect their volunteering to take part in the RCT study, and heightened awareness of prediabetes generated through study processes. They repeated the need to change diet and exercise and some mentioned weight loss. Although a few had made changes, many were uncertain and unconvinced they could change their behaviours. Some wanted more detailed advice, believing the information given was too vague, particularly about their personal risks for developing T2DM. The need for more precise information aligns with other studies about: nutrition guidance;39,40 risk of prediabetes severity;5,41 how to make and sustain lifestyle change decisions;42,43 and advice specifically tailored to particular information needs.44
There was variability in when and how the prediabetes diagnosis was given, with some people inadvertently finding this out, thus reducing the opportunity for them to change lifestyle behaviour earlier.45 Not being told the diagnosis means peoples’ illness perception of prediabetes is not being elicited, particularly how social, emotional, cultural and health literacy factors impact on understanding.46 Similarly, the goal-setting process, which is said to be a ‘central strategy for changing health behaviour’44 and which others33,47 have found important for motivating prediabetes lifestyle change, does not appear to be routinely undertaken.
Māori and Pacific peoples, bar some older women, felt certain they were on an inevitable path to developing T2DM and that nothing would stop this. A similar description of inevitability is reported by Faletau et al. in a NZ study aptly entitled ‘Falling into a deep dark hole’.17 Their study reported participants who were Tongan being fearful and in imminent danger from prediabetes, often conflating it with already having T2DM. For them, prediabetes and T2DM was experienced as a whānau, with interventions best delivered in a collective or community programme.48 Co-designed initiatives by Māori or Pacific providers to change one’s diet are likely to be much more successful the cultural meanings of food and manaakitanga.49
Older Māori and Pacific women in this study were adamant about the need to make significant dietary and exercise changes, and they championed these approaches with whānau. It may be better for Māori and Pacific people’s organisations to take on this championing work rather than individuals alone, as this risks leaving them disenfranchised from their whānau. Beaton et al. reported the role of Māori Health Organisations, in which kuia, senior older Māori women, play a strong role in spearheading this work.50
As typical of qualitative studies, this study has sought to explore the views of a limited number of participants in some depth. The focus group interviews were confined to one geographic region and there were no rural participants. Some participants (GPs and nurses and people with prediabetes) were from the same practices. Although we could not be certain data saturation was reached, there was considerable commonality, particularly in the certainties and uncertainties described by all. The individuals with prediabetes in this study were taking part in a prediabetes intervention trial, and it is likely that the uncertainties reported in this study may be even greater in those not engaged in such a trial.
Conclusion
For GPs, nurses and people with prediabetes, there is uncertainty and certainty about prediabetes and its management. All were certain that prediabetes is increasingly common, and that sustained lifestyle change is difficult. But the following uncertainties were unresolved:
- Can prediabetes be reversed or stabilised and in what circumstances?
- Who with prediabetes progresses to T2DM and who does not, and where should people with prediabetes and GPs and nurses put their efforts?
- Given there are highly respected older Māori and Pacific women who want to promote lifestyle change, how could Māori and Pacific organisations and leadership be better mobilised/supported?
- Which co-designed culturally appropriate prediabetes initiatives should be further investigated, trialled and evaluated?
- How important is weight loss and how do you get a population to lose weight rather than targeting individuals?
- What other public health measures could be used to reverse/halt prediabetes?
Data availability
The data that support this study cannot be publicly shared due to ethical or privacy reasons and may be shared upon reasonable request to the corresponding author if appropriate.
Conflicts of interest
The authors declare no conflicts of interest.
Declaration of funding
This study was funded by the Health Research Council of New Zealand, the Ministry of Health New Zealand, and the Healthier Lives National Science Challenge (grant number 16/724).
[1] Bansal N. Prediabetes diagnosis and treatment: a review. World J Diabetes 2015; 6 296–303.
[2] Brannick B, Wynn A, Dagogo-Jack S. Prediabetes as a toxic environment for the initiation of microvascular and macrovascular complications. Exp Biol Med 2016; 241 1323–31.
[3] New Zealand Society for the Study of Diabetes (NZSSD). Position statement on the diagnosis of, and screeening for type 2 diabetes. 2011. Available at https://t2dm.nzssd.org.nz/Section-112-Screening-for-diabetes-in-asymptomatic-adults [Accessed 14 May 2021]
[4] American Diabetes Association. Prediabetes. 2021. Available at https://www.diabetes.org/a1c [Accessed 7 March 2021]
[5] Teng A, Blakely T, Scott N, et al. What protects against pre-diabetes progressing to diabetes? Observational study of integrated health and social data. Diabetes Res Clin Pract 2019; 148 119–29.
[6] Sallar A, Dagogo-Jack S. Regression from prediabetes to normal glucose regulation: state of the science. Exp Biol Med 2020; 245 889–96.
[7] Cardona-Morrell M, Rychetnik L, Morrell SL, et al. Reduction of diabetes risk in routine clinical practice: are physical activity and nutrition interventions feasible and are the outcomes from reference trials replicable? A systematic review and meta-analysis. BMC Public Health 2010; 10 653
[8] Bommer C, Heesemann E, Sagalova V, et al. The global economic burden of diabetes in adults aged 20–79 years: a cost-of-illness study. Lancet Diabetes Endocrinol 2017; 5 423–30.
[9] Ministry of Health. Annual Data Explorer 2019/20: New Zealand Health Survey. 2020. Available at https://minhealthnz.shinyapps.io/nz-health-survey-2019-20-annual-data-explorer/ [Accessed 14 May 2021]
[10] Coppell KJ, Mann JI, Williams SM, et al. Prevalence of diagnosed and undiagnosed diabetes and prediabetes in New Zealand: findings from the 2008/09 Adult Nutrition Survey. N Z Med J 2013; 126 23–42.
[11] Jansen R, Sundborn G, Cutfield R, et al. Ethnic inequity in diabetes outcomes-inaction in the face of need. N Z Med J 2020; 133 8–10.
[12] Ministry of Health. Cardiovascular Disease Risk Assessment and Management for Primary Care. Wellington: Ministry of Health; 2018.
[13] Ministry of Health & New Zealand Society for the Study of Diabetes. Prediabetes. 2021. Available at https://t2dm.nzssd.org.nz/Section-98-Prediabetes [Accessed 14 May 2021]
[14] Community HealthPathways: 3D. Community HealthPathways: 3D. 2021. Available at https://3d.communityhealthpathways.org/ [Accessed 6 March 2021]
[15] Pan X-R, Li G-W, Hu Y-H, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: the Da Qing IGT and Diabetes Study. Diabetes Care 1997; 20 537–44.
[16] Uusitupa M. Good news from the Da Qing Diabetes Prevention Outcome Study—healthy lifestyles result in long-term cardiovascular benefits. Ann Transl Med 2019; 7 S368
[17] Faletau J, Nosa V, Dobson R, et al. Falling into a deep dark hole: Tongan people’s perceptions of being at risk of developing type 2 diabetes. Health Expect 2020; 23 837–45.
[18] Coppell KJ, Abel SL, Freer T, et al. The effectiveness of a primary care nursing-led dietary intervention for prediabetes: a mixed methods pilot study. BMC Fam Pract 2017; 18 106
[19] Firestone R, Faeamani G, Okiakama E, et al. Pasifika prediabetes youth empowerment programme: evaluating a co-designed community-based intervention from a participants’ perspective. Kōtuitui 2021; 16 210–24.
[20] McLeod M, Stanley J, Signal V, et al. Impact of a comprehensive digital health programme on HbA 1c and weight after 12 months for people with diabetes and prediabetes: a randomised controlled trial. Diabetologia 2020; 63 2559–70.
[21] Barthow C, Hood F, McKinlay E, et al. Food 4 Health-He Oranga Kai: Assessing the efficacy, acceptability and economic implications of Lactobacillus rhamnosus HN001 and β-glucan to improve glycated haemoglobin, metabolic health, and general well-being in adults with pre-diabetes: study protocol for a 2× 2 factorial design, parallel group, placebo-controlled randomized controlled trial, with embedded qualitative study and economic analysis. Trials 2019; 20 464
[22] Morse JM. Simultaneous and sequential qualitative mixed method designs. Qual Inq 2010; 16 483–91.
[23] Gamble E, Parry‐Strong A, Coppell KJ, et al. Development of a structured diabetes self‐management education program specific to the cultural and ethnic population of New Zealand. Nutr Diet 2017; 74 415–22.
[24] Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3 77–101.
[25] Prochaska JJ, Prochaska JO. A review of multiple health behavior change interventions for primary prevention. Am J Lifestyle Med 2011; 5 208–21.
[26] Messina J, Campbell S, Morris R, et al. A narrative systematic review of factors affecting diabetes prevention in primary care settings. PLoS One 2017; 12 e0177699
[27] Herman WH. The cost-effectiveness of diabetes prevention: results from the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study. Clin Diabetes Endocrinol 2015; 1 9
[28] Gong Q, Zhang P, Wang J, et al. Lifestyle interventions in persons with IGT prolong the time free of major diabetes-related complications: 30-year results of the Da Qing Diabetes Prevention Outcome Study (DQDPOS). Am Diabetes Assoc 2020; 7 452–61.
[29] Bell K, Shaw JE, Maple-Brown L, et al. A position statement on screening and management of prediabetes in adults in primary care in Australia. Diabetes Res Clin Pract 2020; 164 108188
[30] Lim RBT, Wee WK, For WC, et al. Health education and communication needs among primary care patients with prediabetes in Singapore: a mixed methods approach. Prim Care Diabetes 2020; 14 254–64.
[31] Wilson N, Grout L, Summers J, et al. Should prioritising health interventions be informed by modelling studies? The case of cancer control in Aotearoa New Zealand. N Z Med J 2021; 134 101–13.
[32] Abel S, Whitehead L, Coppell K. Making dietary changes following a diagnosis of prediabetes: a qualitative exploration of barriers and facilitators. Diabet Med 2018; 35 1693–9.
[33] Abel SL, Whitehead LC, Tipene-Leach DC, et al. Proximal and distal influences on dietary change among a diverse group with prediabetes participating in a pragmatic, Primary Care Nurse-Led Intervention: a qualitative study. Public Health Nutr 2021; 24 6015–26.
[34] Connor D, Coppell K, Gray A, et al. A cost-effectiveness analysis of the prediabetes intervention package (PIP) in primary care: a New Zealand pilot programme. N Z Med J 2019; 132 24–34.
[35] Hilder J, Gray L, Stubbe M, et al. ‘Water dripping on a stone’: a feasibility study of a healthy weight management conversation approach in routine general practice consultations. Fam Pract 2020; 38 246–52.
[36] Farmer A, Edgar T, Gage J, et al. “I Want to Walk with My Moko.” The application of social cognitive theory in the creation of a diabetes prevention documentary with New Zealand Māori. J Health Commun 2018; 23 306–12.
[37] Beaton A, Manuel C, Tapsell J, et al. He Pikinga Waiora: supporting Māori health organisations to respond to pre-diabetes. Int J Equity Health 2019; 18 3
[38] Masters-Awatere B, Rarere M, Gilbert R, et al. He aha te mea nui o te ao? He tāngata! (What is the most important thing in the world? It is people!). Aust J Prim Health 2019; 25 435–42.
[39] Zhang Z, Monro J, Venn BJ. Carbohydrate knowledge and expectations of nutritional support among five ethnic groups living in New Zealand with pre-and type 2 diabetes: a qualitative study. Nutrients 2018; 10 1225
[40] Zhang Z, Monro J, Venn BJ. Development and evaluation of an internet-based diabetes nutrition education resource. Nutrients 2019; 11 1217
[41] Roper KL, Thomas AR, Hieronymus L, et al. Patient and clinician perceptions of prediabetes: a mixed-methods primary care study. Diabetes Educ 2019; 45 302–14.
[42] Kerrison G, Gillis RB, Jiwani SI, et al. The effectiveness of lifestyle adaptation for the prevention of prediabetes in adults: a systematic review. J Diabetes Res 2017; 2017 8493145
[43] Somerville M, Burch E, Ball L, et al. ‘I could have made those changes years earlier’: experiences and characteristics associated with receiving a prediabetes diagnosis among individuals recently diagnosed with type 2 diabetes. Fam Pract 2020; 37 382–9.
[44] O’Brien MJ, Moran MR, Tang JW, et al. Patient perceptions about prediabetes and preferences for diabetes prevention. Diabetes Educ 2016; 42 667–77.
[45] Gopalan A, Lorincz IS, Wirtalla C, et al. Awareness of prediabetes and engagement in diabetes risk-reducing behaviors. Am J Prev Med 2015; 49 512–9.
[46] Petrie KJ, Jago LA, Devcich DA. The role of illness perceptions in patients with medical conditions. Curr Opin Psychiatry 2007; 20 163–7.
[47] Whitehead L, Glass CC, Abel SL, et al. Exploring the role of goal setting in weight loss for adults recently diagnosed with pre-diabetes. BMC Nurs 2020; 19 67
[48] Hindhede AL, Aagaard-Hansen J. Risk, the prediabetes diagnosis and preventive strategies: critical insights from a qualitative study. Crit Public Health 2015; 25 569–81.
[49] Harwood M, Tane T, Broome L, et al. Mana Tū: a whānau ora approach to type 2 diabetes. N Z Med J 2018; 131 76–83.
[50] Beaton A, Manuel C, Tapsell J, et al. Identifying strategic opportunities for Māori community organisations to respond to pre-diabetes: building a platform for integrated care to deliver change that matters to communities. Int J Integr Care 2017; 17 A166
Eileen McKinlay 1 * , Jo Hilder 1 , Fiona Hood 2 , Sonya Morgan 1 , Christine Barthow 2 , Ben Gray 1 , Mark Huthwaite 3 , Mark Weatherall 2 , Julian Crane 2 , Jeremy Krebs 2 , Sue Pullon 1
1 Department of Primary Health Care and General Practice, University of Otago, Wellington, Newtown, Wellington 6021, New Zealand.
2 Department of Medicine, University of Otago, Wellington, Newtown, Wellington 6021, New Zealand.
3 Department of Psychological Medicine, University of Otago, Wellington, Newtown, Wellington 6021, New Zealand.
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Abstract
Introduction: Prediabetes is the asymptomatic precursor to type two diabetes mellitus, a significant and growing public health problem in New Zealand (NZ). Little is known about how general practitioners (GPs) and nurses view prediabetes care, and similarly little is known about how people with prediabetes view their condition and care.
Aim: This study aimed to investigate the views of NZ GPs and nurses, and people with prediabetes about prediabetes and its management.
Methods: This was a mixed qualitative methods study that is part of a randomised control trial of a prediabetes intervention.
Results: Three key themes emerged from the health professional data (GPs and nurses) and another three themes emerged from people with prediabetes data. GPs and nurses were uncertain about the progression of prediabetes; they felt prediabetes was not a priority and they were unsure about what to advise. People with prediabetes were uncertain about the diagnosis and information given to them; they were unsure about what to do about prediabetes and they found lifestyle change hard.
Discussion: GPs, nurses and people with prediabetes, expressed much uncertainty, but also some certainty about prediabetes. All were certain that prediabetes is common and increasing and that sustained lifestyle change was very difficult. But uncertainty prevailed about whether, in reality, prediabetes could be stopped, who would be most likely to benefit from lifestyle interventions and how best to achieve these. Older Māori and Pacific women were keen to promote lifestyle change and this appeared best done through Māori and Pacific peoples’ organisations by means of co-designed interventions.
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Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated "AS IS" and "AS AVAILABLE" and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of the translation functionality and any output derived there from. Hide full disclaimer