Dose Adjustment for Normal Eating: a qualitative longitudinal exploration of the food and eating practices of type 1 diabetes patients converted to flexible intensive insulin therapy in the UK.
OBJECTIVE
To explore whether, and why, patients change their food and eating practices following conversion to flexible intensive insulin therapy (FIIT), a regimen which requires quick acting insulin doses to be matched to the carbohydrate content of meals/snacks consumed.


METHODS
repeat, in-depth interviews with 30 type 1 diabetes patients converted to FIIT recruited from Dose Adjustment for Normal Eating (DAFNE) courses in the UK. Data were analysed using an inductive, thematic approach.


RESULTS
despite the potential of FIIT to enable greater dietary flexibility and freedom, most patients reported food and eating practices which were remarkably resistant to change. In some cases, FIIT adoption resulted in greater dietary rigidity over time. The opportunities FIIT presented for greater dietary freedom were counterbalanced by new challenges and burdens (e.g. having to simplify food choices to make carbohydrate estimation easier). Due to the emphasis FIIT places on carbohydrate counting, and patients' fears of hypos, low/no carbohydrate foodstuffs sometimes came to be seen as the healthiest or safest options.


CONCLUSIONS
concerns that FIIT may result in more excessive or unhealthy eating appear largely unfounded; however, consideration needs to be paid to the ways in which patients' conceptualisations of, and relationship with, food may change following FIIT conversion.
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK. j.lawton@ed.ac.uk
J
J
Lawton
D
D
Rankin
D D
DD
Cooke
M
M
Clark
J
J
Elliot
S
S
Heller
D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D017281:Cost of Illness; D003922:Diabetes Mellitus, Type 1 / Q000178:diet therapy / Q000188:drug therapy / Q000523:psychology; D004032:Diet / Q000009:adverse effects / Q000523:psychology; D050528:Diet, Carbohydrate-Restricted / Q000523:psychology; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects; D010353:Patient Education as Topic; D018802:Patient-Centered Care; D006113:United Kingdom; D055815:Young Adult
D004040:Dietary Carbohydrates; D007328:Insulin