The study on the impediments to good diabetes control by Elliott et al1 corresponds with our findings from an interview study of patients with diabetes from a deprived background in the northeast of England. We undertook semi-structured interviews with eight patients with established type 2 diabetes from one general practice and explored their perceived barriers to making lifestyle changes. The incidence of diabetes in the northeast of England is relatively high and is known to be inversely related to a low socioeconomic status,2–4 but there is little research exploring the reasons for the link with deprivation. Our results highlighted four common themes: dietary education, motivation to change, family support, and comorbidities.
Patient education was the most commonly reported barrier, related to poor dietary education and misperceptions gained during childhood on healthy foods. Participants struggled to find the motivation to change their lifestyles. This fluctuated in some participants, who reported returning to bad habits during prolonged periods of no medical contact. Interestingly, the level of perceived support a patient felt they had seemed to correlate with their overall motivation. Participants who were in a relationship commented on how their partner acted as a source of continual encouragement to help them continue with the lifestyle regimen they had been given. However, following a healthy lifestyle was challenging for family members of our patients, especially those who were part of a big family with children. Surprisingly, financial barriers were felt to be less of an issue than might have been expected: most participants suggested that the cost of leading a healthier lifestyle was balanced by the cost of unhealthy habits such as ‘takeaways’. Finally, the participants’ overall health and the consequential impact of their comorbidities were highlighted as an important barrier to following a healthy lifestyle.
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