Breen C, McKenzie K, Yoder R, Ryan M, Gibney M J, O'Shea D
Endocrine Unit, St Columcille's Hospital, Loughlinstown, County Dublin, Ireland.
School of Public Health, Physiotherapy and Population Science, University College Dublin, Belfield, Dublin 4, Ireland.
J Hum Nutr Diet. 2016 Apr;29(2):146-55. doi: 10.1111/jhn.12292. Epub 2015 Jan 26.
A healthy diet is the cornerstone of type 2 diabetes (T2DM) self-management. Carbohydrate is of particular interest as the nutrient with the greatest direct effect on blood glucose (BG) levels. The present study aimed to explore T2DM patients' understanding of carbohydrate and beliefs around the role of carbohydrate in T2DM management.
Fifteen semi-structured interviews were conducted with T2DM patients. Interviews were audio-recorded and transcribed, and a deductive thematic approach to analysis was employed using the Framework method.
Four significant themes emerged: (i) a naïve conceptual understanding of carbohydrate and sugar-centric specificity to dietary behaviours; (ii) a narrow focus on BG management to the neglect of overall dietary balance; (iii) positive reception of moderate dietary advice focused on portion control from healthcare professionals (HCPs); and (iv) the impact of external moderators of dietary choices, including the influence of significant others, emotional and opportunistic eating and budgetary constraints.
Participants' beliefs and understanding of carbohydrate led to an overemphasis on sugar restriction for blood glucose control to the neglect of their overall dietary balance. Diabetes educators need to place greater emphasis on the role of various types of carbohydrate foods for glycaemic control, as well as on concepts of wider metabolic health, during T2DM dietary education. Participants placed a high level of trust and value on practical, moderate portion control advice from HCPs regarding carbohydrate foods. However, HCPs need to be cognisant of external moderators of behaviour, such as the influence of family and friends, budgetary constraints and environmental eating triggers.
健康饮食是2型糖尿病（T2DM）自我管理的基石。碳水化合物作为对血糖（BG）水平有最直接影响的营养素，尤其受到关注。本研究旨在探讨T2DM患者对碳水化合物的理解以及关于碳水化合物在T2DM管理中作用的信念。
对T2DM患者进行了15次半结构化访谈。访谈进行了录音和转录，并采用框架法进行演绎主题分析。
出现了四个重要主题：（i）对碳水化合物的幼稚概念理解以及以糖为中心对饮食行为的特异性；（ii）将重点狭隘地放在血糖管理上，而忽视了整体饮食平衡；（iii）积极接受医疗保健专业人员（HCPs）给出的以控制份量为重点的适度饮食建议；（iv）饮食选择的外部调节因素的影响，包括重要他人的影响、情绪化和机会性进食以及预算限制。
参与者对碳水化合物的信念和理解导致过度强调限制糖摄入以控制血糖，而忽视了他们的整体饮食平衡。糖尿病教育者在T2DM饮食教育过程中需要更加强调各类碳水化合物食物对血糖控制的作用，以及更广泛的代谢健康概念。参与者高度信任并重视HCPs关于碳水化合物食物的实用、适度份量控制建议。然而，HCPs需要认识到行为的外部调节因素，如家人和朋友的影响、预算限制和环境饮食诱因。
