Caring for people with type 1 diabetes mellitus engaging in disturbed eating or weight control: A qualitative study of practitioners' attitudes and practices

Aims and objectives. To explore the attitudes and practices of hospital-based healthcare professionals toward people with type 1 diabetes mellitus (T1DM) exhibiting disturbed eating or weight control. Background. Eating disturbances and insulin manipulation are common among individuals with T1DM, although little is known about how these behaviors are assessed and managed in practice. Design. Qualitative study. Methods. Face-to-face, semi-structured interviews were conducted with 20 professionals from four hospitals in England, all of which were taped and transcribed verbatim and analysed using a framework approach. Results. Four main themes were identified from the data collected, which related to the classification, detection and treatment of eating disturbances among people with T1DM and professionals' lack of training in this area. For example, interviewees were unclear about what should be considered 'disordered' eating among individuals with T1DM. Participants described a paucity of immediately available services to which individuals could be referred, if they were felt to require extra help, and stated that they felt uncertain about managing these patients without outside support because of their limited training in the treatment of eating disorders. Conclusions. A lack of clarity as to what constitutes a problem among those with T1DM in relation to eating and weight control and an absence of follow-up services for them contributed to a sense of anxiety expressed by interviewees when faced with such a patient. Relevance to clinical practice. Effective interventions addressing dangerous eating or weight control in people with diabetes are sorely needed, as is better training of healthcare professionals on this topic. © 2008 The Authors.