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. 2024 Aug 5:13:e28.
doi: 10.1017/jns.2024.30. eCollection 2024.

Barriers and enablers to engagement with a type 2 diabetes remission project in the North East of England: qualitative perspectives of patients

Ruth C Boocock  1   2 , Anna Haste  2   3 , Helen J Moore  2   3 , Amelia A Lake  1   2
Affiliations

Barriers and enablers to engagement with a type 2 diabetes remission project in the North East of England: qualitative perspectives of patients

Ruth C Boocock et al. J Nutr Sci. .

Abstract

This qualitative research sought to identify factors influencing patient choice of, and patient-related internal and external enablers and barriers to engagement with, type 2 diabetes (T2D) remission strategies offered by the Remission in diabetes (REMI.D) project. Patients had a choice of three diets: Total Diet Replacement (TDR)-Formula Food Products, TDR-Food, and Healthy lifestyle approach; and three activity pathways: Everyday life, General Practitioner referral, and Social hub. Semi-structured interviews were recorded and transcribed. Thematic analysis used the Framework Method and NVivo 12 to assist with generation and organisation of codes, inductive and deductive (Theoretical Domains Framework). The REMI.D project was a place-based approach (place in this case being defined as two local authorities with significant rates of deprivation) situated in the North East of England. Twenty patients out of a possible 65 patients took part. Areas of interest included: patient choice, patient intention, patient adherence, patient non-adherence, and patient stigma. Addition of a more moderate dietary strategy (not dissimilar to the diet in the Healthier You NHS Diabetes Prevention Programme) to the existing NHS England T2D Path to Remission programme may enable more patients to achieve remission or delayed progression with deprescribing of diabetes medications. Embedding a tailored physical activity path within or as a bolt-on to the NHS programme requires consideration. Limited resources should be targeted towards patients who identify with more barriers or fewer opportunities for health behaviour modification. Further research on use of virtual programmes in deprived areas is warranted.

Keywords: COM-B:, Capability Opportunity Motivation – Behaviour; COVID-19:, Coronavirus; DIADEM, Diabetes Intervention Accentuating Diet and Enhancing Metabolism; DIAMOND, Diabetes Education and Self-Management for Ongoing and Newly Diagnosed; DiRECT, Diabetes Remission Clinical Trial; GP:, General practitioner; IMD:, Index of multiple deprivation; NIHR:, National Institute for Health Research; Patient interviews; Qualitative research; REMI.D:, Remission in diabetes; Remission strategy; T2D:, Type 2 diabetes; TDF:, Theoretical domains framework; TDR:, Total diet replacement; Type 2 diabetes.

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Figures

Fig. 1.
Fig. 1.
Type 2 diabetes remission strategies, including the three interview groups, for this qualitative research.
Fig. 2.
Fig. 2.
Visual representation of five areas of interest with associated theoretical domain framework domains.
See this image and copyright information in PMC

References

    1. Taylor R, Al-Mrabeh A, Zhyzhneuskaya S, et al. Remission of human type 2 diabetes requires decrease in liver and pancreas fat content but is dependent upon capacity for β cell recovery. Cell Metab. 2018;28(4):547–56.e3. - PubMed
    1. DUK. Weight Loss can Put Type 2 Diabetes into Remission for at Least 5 Years. London: Diabetes UK; 2023.
    1. DUK. Position Statement: Remission in Adults with Type 2 Diabetes. London: Diabetes UK; 2021.
    1. NHS. Care Processes and Treatment Targets 2020–21. Leeds: NHS Digital; 2022.
    1. Ministry of Housing, Communities & Local Government. The English Indices of Deprivation 2019. London: Ministry of Housing, Communities & Local Government; 2019.

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