Joslin Diabetes Center, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Diabet Med. 2022 Aug;39(8):e14887. doi: 10.1111/dme.14887. Epub 2022 May 28.
Although binge-eating disorder (BED) is a common comorbidity of type 2 diabetes, little is known about the treatment experiences for persons with both conditions. Our aim was to explore perceptions of Primary Care Providers' (PCPs') treatment among adult women with both diagnoses.
In this qualitative descriptive study, we conducted semi-structured interviews with a sample of 21 women (90% non-Hispanic white; mean age 49 ± 14.8 years, mean body mass index [BMI] 43.8 ± 8.4; 48% had type 2 diabetes, mean HbA 68 mmol/mol, 8.4%) who had previously participated in a secondary care specialized eating disorder treatment programme. Interviews were audio-recorded, transcribed and analysed using thematic analysis and NVivo 12.
Participants described PCPs' helpful and unhelpful attitudes and behaviours during type 2 diabetes and BED treatment experiences. Helpful treatment was experienced when PCPs demonstrated a person-centred approach by providing adequate diabetes education, individualized care and non-judgmental attitudes from which participants reported increased understanding of diabetes and BED, improved diabetes self-care and fewer negative self-perceptions. Unhelpful treatment occurred when PCPs did not provide sufficient diabetes education and manifested deficient understanding of BED characterized by simplistic advice or judgmental attitudes, from which participants reported having limited knowledge and understanding of diabetes and BED, low self-efficacy, diminished trust and feelings of guilt, shame and failure.
We propose a preliminary pathways treatment model derived from our findings, which utilizes integrated type 2 diabetes and BED education and person-centred collaboration. This preliminary model needs to be tested in quantitative research with a larger sample.
尽管暴食障碍（BED）是 2 型糖尿病的常见共病，但人们对同时患有这两种疾病的患者的治疗经验知之甚少。我们的目的是探讨初级保健提供者（PCP）对这两种诊断患者的治疗看法。
在这项定性描述性研究中，我们对 21 名女性（90%为非西班牙裔白人；平均年龄 49±14.8 岁，平均体重指数[BMI]43.8±8.4；48%患有 2 型糖尿病，平均 HbA1c68mmol/mol，8.4%）进行了半结构式访谈，这些女性之前曾参加过二级专门治疗饮食障碍的治疗计划。访谈以音频形式记录、转录，并使用主题分析和 NVivo12 进行分析。
参与者描述了 PCP 在 2 型糖尿病和 BED 治疗经历中的有益和无益的态度和行为。当 PCP 表现出以患者为中心的方法，提供足够的糖尿病教育、个性化护理和非评判态度时，治疗是有益的，参与者报告说，这增加了对糖尿病和 BED 的理解，改善了糖尿病自我护理，减少了负面自我认知。当 PCP 没有提供足够的糖尿病教育，并表现出对 BED 的理解不足时，治疗是无益的，其特征是简单的建议或评判态度，参与者报告说，他们对糖尿病和 BED 的了解和理解有限，自我效能感低，信任和内疚、羞耻和失败感减弱。
我们从研究结果中提出了一个初步的路径治疗模型，该模型利用 2 型糖尿病和 BED 的综合教育和以患者为中心的合作。该初步模型需要在更大的样本中进行定量研究来测试。
