Identifying key moments in type 2 diabetes management: a qualitative study of the experiences of people with type 2 diabetes and diabetes health coaches

OBJECTIVE: For people with type 2 diabetes who are overweight, weight loss increases the likelihood of achieving diabetes remission. The aim here was to draw on the experiences of people living with type 2 diabetes and coaches who deliver type 2 diabetes prevention and remission programmes. This was done to develop a service that increases the proportion of people who achieve remission by identifying an effective weight management service. RESEARCH DESIGN AND METHODS: A qualitative researcher and co-researcher with type 2 diabetes conducted 37 narrative interviews with adults with type 2 diabetes (October 2022-June 2023) and 16 semi-structured interviews with health coaches delivering type 2 diabetes programmes in England. Data were analysed using Reflexive Thematic Analysis. Participants were diverse in ethnicity, socioeconomic status, age, gender and years since diabetes diagnosis. RESULTS: Four themes were generated relating to moments in a person's diabetes care: (1) coming to terms with diagnosis, (2) lightbulb moments, (3) sustaining change as normal and (4) becoming expert/building confidence. These four themes were united under a high-level interpretivist theme: 'Same journey, different experience', capturing the mismatch between a linear rigid care pathway described by coaches and the diversity of experience of people living with type 2 diabetes. CONCLUSIONS: Coaches and people with type 2 diabetes are aligned on their reports of key moments in adapting to diabetes. Participants' desire for flexibility in their care contrasted with coach reports of rigid service provision. These insights may enable more people with type 2 diabetes to engage and adhere to weight management services aimed at diabetes remission.