Diabet. Med. 27, 1060–1065 (2010) Aims  To identify psychosocial factors associated with the use of continuous glucose monitoring by adults with Type 1 diabetes.Methods  Twenty adult patients (aged 45 ± 15 years, diabetes duration 25 ± 19 years, 50% female) followed at our site in the multi‐centre Juvenile Diabetes Research Foundation continuous glucose monitoring trial were divided into three groups: Glycated haemoglobin (HbA_1c) Responders who demonstrated an improvement in glycaemic control with continuous glucose monitoring (baseline HbA_1c≥ 7.0%, HbA_1c reduction greater than or equal to 0.5%), Hypoglycaemia Responders (baseline HbA_1c < 7.0%) who demonstrated decreased time < 3.9 mmol/l while remaining within target HbA_1c, and HbA_1c Non‐Responders (baseline HbA_1c≥ 7.0%, HbA_1c reduction less than 0.5%). Subjects participated in semi‐structured interviews focusing on their psychosocial experiences with continuous glucose monitoring.Results  Three major themes were identified that differentiated Responders (including both the HbA_1c and Hypoglycaemia groups) from Non‐Responders: (i) coping with frustrations—Responders used self‐controlled rather than emotions‐based coping when faced with continuous glucose monitoring frustrations; (ii) use of information—Responders used retrospective pattern analysis, not just minute‐by‐minute data analysis, in glycaemic management; (iii) ‘significant other’/spousal involvement—Responders endorsed interest, encouragement and participation by their loved ones. Both Responders and Non‐Responders expressed body image concerns when wearing continuous glucose monitoring devices.Conclusions  This qualitative study points to the importance of coping skills, retrospective review of data, and ‘significant other’ involvement in the effective use of continuous glucose monitoring. These findings will inform clinical initiatives to improve patient selection and training in the use of this new technology and have served as the basis for development of quantitative surveys to be used in clinical practice.

Purpose: The purpose of this study was to explore perceptions that emerging adults with type 1 diabetes (T1D) have of their patient-provider relationships across the transition from pediatric to adult care. Methods: Twenty-six emerging adults with T1D (mean age 26.2 ± 2.5 years) participated in 5 focus groups stratified by current level of glycemic control (A1C). Coded audio-recorded data were analyzed using thematic analysis and aided by NVivo software. Results: Three major themes emerged from the analysis: (1) loss and gain in provider relationships across the transition—patients expressed 3 key responses to leaving pediatric providers that differed by A1C levels: sad reluctance and “natural progression” (mean A1C ± SD 7.4% ± 0.6%) and wanting to go (mean A1C ± SD 9.8% ± 1.0%); (2) partners in care versus on one’s own—patients valued how adult providers’ collaborative conversations promoted their involvement and accountability compared to “parent-centric” interactions with pediatric providers, but they also expressed ambivalence over increased independence in adult care; (3) improving provider approaches to transition—patients recommended that pediatric providers actively promote emerging adults’ autonomy while maintaining parental support, communication with adult providers, and follow-up with transitioning patients. Conclusions: Findings highlight the importance of enhanced provider awareness of T1D emerging adults’ complex feelings about the transition in care. Improved integration of individual- and family-centered approaches to developmentally tailored diabetes care is needed to augment patient and provider relationships.

The detrimental effects of weight stigma are a growing concern as a contributor to negative physical and mental health outcomes, disparities in care, and healthcare avoidance. Research exploring the impact of weight-neutral healthcare is limited but suggests weight-neutral interventions are associated with positive psychological and behavioral outcomes. Little is known about patients' lived experiences receiving weight-neutral healthcare. We conducted semi-structured interviews between Feb 5, 2019 and Feb 25, 2020 with 21 women (90% non-Hispanic white, mean age 49 ± 14.8 years) who had type 2 diabetes or prediabetes and high body weight (mean body mass index 43.8 ± 8.4, range: 30.2-63.9) and previously attended a specialized treatment program for binge eating disorder. We recruited individuals with type 2 diabetes or prediabetes who completed of >2 weeks of a specialized binge eating disorder treatment program with the ability to participate in an English-spoken interview and did not have cognitive impairment or severe psychopathology that would limit recall or engagement in the interview. Interviews were analysed using thematic analysis and Nvivo software. The main outcome we studied was patients' lived experience in healthcare settings and in a weight-neutral eating disorder treatment program. Participants reported experiencing weight stigma in healthcare encounters and believed this decreased the quality of care they received. While participants frequently attempted to lose weight, they experienced embarrassment, internalized a sense of failure, and felt blamed for their weight and health conditions. In describing experiences within a weight-neutral paradigm, participants reported that helpful elements included consistency in the eating pattern (emphasizing adequate, varied, and nourishing intake), sufficient and specific education, and comprehensive support. Reported impacts included decreased binge episodes, experiencing less shame, and increased resiliency following treatment. Some participants experienced the weight-neutral treatment recommendations and the absence of the pursuit of weight loss as challenging. Weight-neutral treatment may improve psychological and behavioral outcomes regarding binge eating, and longitudinal, quantitative research is warranted. These findings are useful to decrease weight stigma in provider-patient interactions. The Dudley Allen Sargent Research Fund, Boston University.