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Dr. Katie Weinger, of Harvard Medical School, Boston, and colleagues had adult insulin pump users take part in focus groups that were loosely formed on the basis of the subjects' A1C level. Five reviewers used NVivo2 qualitative software to code transcripts of the focus group meetings into themes.
A total of 30 long-term diabetics participated in five focus groups. Two of the groups had low mean A1C (6.8%), one had mild A1C (7.8%), and two had high A1C (9.1%). The authors report that three major themes were identified: impact on diabetes self-care, emotional reactions to the insulin pump, and body image and social acceptance.
Subjects in the low A1C group described the pump as a tool to meet glycemic goals. These patients had a more active approach to diabetes. Patients who described the pump as a panacea had a more passive approach to self-care and had poorer glycemic control.
Patients in the low A1C groups reported emotional reactions to starting the insulin pump that reminded them of feelings they experienced when they were initially diagnosed with diabetes. Subjects in the high A1C groups did not report experiencing these feelings.
"Participants in the low A1C groups stated that the pump helped them feel more accepting of their diabetes, less ashamed of it, and able to speak about it to others for the first time," Dr. Weinger and colleagues write.
"In contrast, high A1C group participants spoke of being 'tired' of the pump," they note. "They described feeling discouraged and 'frustrated' that the pump did not 'fix everything' and that 'it's still a lot of work.'"
The researchers report that women were more concerned than men about body image and social acceptance with insulin pump use.
"Interventions to improve diabetes management with pump use should include evaluation and discussion of active versus passive approaches to self-care, recall of diabetes diagnosis, expectations of the pump, and pump-related self-consciousness and body image concerns," they conclude.
Diabetes Care 2007;30:549-554.
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DID YOU KNOW:
Physical Activity of Moderate Intensity and Risk of Type 2 Diabetes: To systematically evaluate the evidence for an association between physical activity of moderate intensity and risk of type 2 diabetes, a medline search was done and a summary with relative risks (RRs) using a random-effects model for the highest versus the lowest reported duration of activities. From the results,10 prospective cohort studies of physical activity of moderate intensity and type 2 diabetes, were identified including a total of 301,221 participants and 9,367 incident cases. Five of these studies specifically investigated the role of walking. The summary RR of type 2 diabetes was 0.69 (95% CI 0.58–0.83) for regular participation in physical activity of moderate intensity as compared with being sedentary. Similarly, the RR was 0.70 (0.58–0.84) for regular walking (typically  2.5 h/week brisk walking) as compared with almost no walking. The associations remained significant after adjustment for BMI. Similar associations were observed in men and women and in the U.S. and Europe. In conclusion the findings indicate that adherence to recommendations to participate in physical activities of moderate intensity such as brisk walking can substantially reduce the risk of type 2 diabetes. Diabetes Care 30:744-752, March, 2007
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