Understanding antagonism and synergism: A qualitative assessment of weight management in youth with Type 1 diabetes mellitus. (March 2018)

• Record Type: Journal Article
• Authors: Kahkoska, Anna R.; Watts, Madison E.; Driscoll, Kimberly A.; Bishop, Franziska K.; Mihas, Paul; Thomas, Joan; Law, Jennifer R.; Jain, Nina; Mayer-Davis, Elizabeth J.
• Is Part Of: Obesity medicine. Volume 9(2018)
• Page Start: 21
• Page End: 31
• Publication Date: 2018-03
• Subjects: Type 1 diabetes -- Pediatric obesity -- Weight management -- Qualitative research; Obesity -- Periodicals; Obesity; Obesity; Periodicals; Periodicals; 616.398005
• DOI: 10.1016/j.obmed.2017.12.001
• Languages: English
• ISSNs: 2451-8476

Abstract

Abstract: Aims: No current clinical guidelines focus on weight management in youth with type 1 diabetes mellitus (T1DM). Our aim was to characterize the patient-perceived experience and barriers to weight management in youth with T1DM. Methods: Participants were recruited from the University of North Carolina (n = 16, 56% female, 60% White, 50% insulin pump users, mean age 14.8 years, mean HbA1c 8.5% (69 mmol/mol)) and the University of Colorado (n = 18, 50% female, 80% white, 53% pump users, mean age 15.3 years, mean HbA1c 9.3% (78 mmol/mol)). Focus groups were stratified by sex and weight status (BMI cutoff = 25). Discussions were guided by a standardized set of questions, audio-taped, transcribed, and analyzed thematically using inductive qualitative methods. Results: Youth with T1DM expressed four interrelated themes of antagonism between type 1 diabetes and weight management: dysregulated appetite, disruption of blood glucose levels associated with changing diet/exercise, hypoglycemia as a barrier to weight loss, and the overwhelming nature of dual management of weight and glycemic control, and two interrelated themes of synergism: improvement in shared, underlying heath behaviors and exercise as a tool for weight and glycemic control. Variation in emphasis of specific thematic elements was greatest across sex. Youth identified five major components of a weight management program for T1DM: intensified glucose management, healthy diet with known carbohydrate content, exercise, individualization and flexibility, and psychosocial and peer support. Conclusions: There is critical need for personalized, T1DM-specific weight recommendations to overcome disease-specific barriers to weight management in the context of T1DM. Highlights: We characterized the patient-perceived experience and barriers to weight management in youth with T1D. Youth with type 1 diabetes described scenarios where weight management practices are challenged by diabetes management. Youth described aspects of weight management that were perceived as productive for diabetes management as well. Youth did not endorse T1D-specific disordered eating behaviors such as insulin manipulation or purging. However, youth with T1D face other disease-specificbarriers to weight control, such as hypoglycemia.