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A qualitative investigation of patients' understanding of carbohydrate in the clinical management of type 2 diabetes

16 / 04 / 15

The objective of this qualitative study was to explore patients’ understanding of carbohydrates and their beliefs around the role of carbohydrates in the dietary management of type 2 diabetes (T2D).

A one-to-one semi-structured interview was conducted with 8 Irish males and 7 females diagnosed with T2D for a mean of 10.6 years and already receiving usual care. Understanding of 3 areas of interest were examined: (1) participants' beliefs, (2) their reported behaviours and (3) advice/messages received in relation to the role of carbohydrate in the management of T2D.

Four major themes emerged:

  • Patients were focused on restricting sugar rather than total carbohydrates. Starchy foods were understood as containing carbohydrate but sugar was not- it was regarded as a stand-alone food group.
  • Patients focused on blood glucose control and neglected overall dietary balance. Weight control and reducing risk of cardiovascular disease were considered secondary. The amount of fat or calories in a food was less important than sugar content. The sugar content of fruit was a concern.
  • They like advice from health professionals about portion control of carbohydrate containing foods. This reinforced the idea that a wide variety of foods was OK, provided you ate them in the right amounts.
  • External influences on eating behaviour were significant, such as family and friends and budget constraints as well as emotion.

Participants' beliefs and naive conceptual understanding of carbohydrates led to a narrow focus on sugar restriction for blood glucose control to the neglect of overall dietary balance. Education needs to place greater emphasis on the role of various types of carbohydrate foods for glycaemic control as well as on concepts of wider metabolic health.

Limitations include the small sample size and self-selection. The views of participants may not be representative of all T2D patients.