Adapting an online guided self-help intervention for the management of binge eating in adults with type 2 diabetes: The POSE-D study.

AIMS: People with type 2 diabetes (T2D) are more likely to experience binge eating than the general population, which may interfere with their diabetes management. Guided self-help (GSH) is the recommended treatment for binge-eating disorder, but there is currently a lack of evidenced treatment for binge eating in individuals living with T2D. The aims of the current study were to adapt an existing evidence-based GSH intervention using the principles of co-design to make it available online, suitable for remote delivery to address binge eating specifically in adults living with T2D. The Working to Overcome Eating Difficulties GSH intervention comprises online GSH materials presented in seven sections delivered over 12 weeks, supported by a trained Guide. METHODS: In order to adapt the intervention, we held four collaboration workshops with three expert patients recruited from diabetes support groups, eight healthcare professionals and an expert consensus group. We used thematic analysis to make sense of the data. RESULTS AND CONCLUSIONS: The main themes included; keeping the GSH material generic, adapting Sam the central character, tailoring the dietary advice and eating diary. The length of Guidance sessions was increased to 60 min, and Guide training was focussed around working with people with diabetes.

High prevalence of vitamin D insufficiency in a United Kingdom urban morbidly obese population: implications for testing and treatment.

BACKGROUND: Current recommendations suggest universal screening of vitamin D status before bariatric surgery to identify individuals at risk for postoperative deficiency. However little is known about the magnitude or severity of vitamin D insufficiency in the morbidly obese population awaiting bariatric surgery in the United Kingdom. The purpose of this prospective observational study was to assess the prevalence and determinants of vitamin D insufficiency in an urban multiethnic U.K. population awaiting bariatric surgery. METHODS: Consecutive patients attending a morbid obesity service were comprehensively assessed using a recognized obesity staging tool. Data collected included 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), corrected calcium (Ca(2+)), body mass index (BMI), and the presence and severity of obesity associated co-morbidities, including type 2 diabetes (T2 DM), cardiovascular disease (CVD), depression, obstructive sleep apnea (OSA), and functional limitation. RESULTS: Of the 118 patients assessed, 79% were female, and 21% were male, with BMI of 52.6 ± 9.4 kg/m(2) (mean ± standard deviation) and mean age of 44 ± 11 years. Twenty-four percent had T2 DM, 28% CVD, 31% OSA, and 21% depression. Vitamin D insufficiency was found in 90% of the population, with a median serum 25(OH)D of 8.8 ng/mL. Secondary hyperparathyroidism was present in 43% of those with vitamin D insufficiency. Risk was not influenced by ethnicity, age, or gender. However severe functional limitation was associated with lower vitamin D status. CONCLUSION: Regardless of ethnicity, vitamin D insufficiency appears to be typical among this clinic population; therefore, routine vitamin D supplementation is suggested for all individuals awaiting bariatric surgery rather than testing vitamin D status in an attempt to identify high-risk individuals.

Nutrition-related health management in a Bangladeshi community.

The British Bangladeshi community is one of the youngest and fastest growing ethnic minority groups in the UK. Many report poor socio-economic and health profiles with the existence of substantial health inequalities, particularly in relation to type 2 diabetes. Although there is compelling evidence for the effectiveness of lifestyle interventions in the prevention of type 2 diabetes, there is little understanding of how best to tailor treatments to the needs of minority ethnic groups. Little is known about nutrition related lifestyle choices in the Bangladeshi community or the factors influencing such decisions. Only by exploring these factors will it be possible to design and tailor interventions appropriately. The Bangladeshi Initiative for the Prevention of Diabetes study explored lay beliefs and attitudes, religious teachings and professional perspectives in relation to diabetes prevention in the Bangladeshi community in Tower Hamlets, London. Contrary to the views of health professionals and previous research, poor knowledge was not the main barrier to healthy lifestyle choices. Rather the desire to comply with cultural norms, particularly those relating to hospitality, conflicted with efforts to implement healthy behaviours. Considerable support from Islamic teachings for diabetes prevention messages was provided by religious leaders, and faith may have an important role in supporting health promotion in this community. Some health professionals expressed outdated views on community attitudes and were concerned about their own limited cultural understanding. The potential for collaborative working between health educators and religious leaders should be explored further, and the cultural competence of health professionals addressed.

Prevention of type 2 diabetes in British Bangladeshis: qualitative study of community, religious, and professional perspectives.

OBJECTIVE: To understand lay beliefs and attitudes, religious teachings, and professional perceptions in relation to diabetes prevention in the Bangladeshi community. DESIGN: Qualitative study (focus groups and semistructured interviews). SETTING: Tower Hamlets, a socioeconomically deprived London borough, United Kingdom. PARTICIPANTS: Bangladeshi people without diabetes (phase 1), religious leaders and Islamic scholars (phase 2), and health professionals (phase 3). METHODS: 17 focus groups were run using purposive sampling in three sequential phases. Thematic analysis was used iteratively to achieve progressive focusing and to develop theory. To explore tensions in preliminary data fictional vignettes were created, which were discussed by participants in subsequent phases. The PEN-3 multilevel theoretical framework was used to inform data analysis and synthesis. RESULTS: Most lay participants accepted the concept of diabetes prevention and were more knowledgeable than expected. Practical and structural barriers to a healthy lifestyle were commonly reported. There was a strong desire to comply with cultural norms, particularly those relating to modesty. Religious leaders provided considerable support from Islamic teachings for messages about diabetes prevention. Some clinicians incorrectly perceived Bangladeshis to be poorly informed and fatalistic, although they also expressed concerns about their own limited cultural understanding. CONCLUSION: Contrary to the views of health professionals and earlier research, poor knowledge was not the main barrier to healthy lifestyle choices. The norms and expectations of Islam offer many opportunities for supporting diabetes prevention. Interventions designed for the white population, however, need adaptation before they will be meaningful to many Bangladeshis. Religion may have an important part to play in supporting health promotion in this community. The potential for collaborative working between health educators and religious leaders should be explored further and the low cultural understanding of health professionals addressed.