title: A qualitative synthesis of diabetes self-management strategies for long term medical outcomes and quality of life in the UK.
abstract: BACKGROUND
  Qualitative research on self-management for people with Type 2 Diabetes Mellitus (T2DM) has typically reported one-off retrospective accounts of individuals' strategies. The aim of this research was to identify the ways in which self-management strategies are perceived by people with T2DM as being either supportive or unsupportive over time, by using qualitative findings from both longitudinal intervention studies and usual care.
  
  
  METHODS
  A systematic review of qualitative literature, published between 2000 and 2013, was conducted using a range of searching techniques. 1374 prospective qualitative papers describing patients' experiences of self-management strategies for T2DM were identified and screened. Of the 98 papers describing qualitative research conducted in the UK, we identified 4 longitudinal studies (3 intervention studies, 1 study of usual care). Key concepts and themes were extracted, reviewed and synthesised using meta-ethnography techniques.
  
  
  RESULTS
  Aspects of self-management strategies in clinical trials (e.g. supported exercise regimens) can be perceived as enabling the control of biomarkers and facilitative of quality of life. In contrast, aspects of self-management strategies outwith trial conditions (e.g. self-monitoring) can be perceived of as negative influences on quality of life. For self-management strategies to be sustainable in the long term, patients require a sense of having a stake in their management that is appropriate for their beliefs and perceptions, timely information and support, and an overall sense of empowerment in managing their diabetes in relation to other aspects of their life. This enables participants to develop flexible diabetes management strategies that facilitate quality of life and long term medical outcomes.
  
  
  CONCLUSIONS
  This synthesis has explored how patients give meaning to the experiences of interventions for T2DM and subsequent attempts to balance biomarkers with quality of life in the long term. People with T2DM both construct and draw upon causal accounts as a resource, and a means to counter their inability to balance medical outcomes and quality of life. These accounts can be mediated by the provision of timely and tailored information and support over time, which can allow people to develop a flexible regimen that can facilitate both quality of life and medical outcomes.
authors.affiliation: Institute of Health Research, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, UK. j.frost@exeter.ac.uk.
authors.forename: Julia
authors.initials: J
authors.lastname: Frost
authors.forename: Ruth
authors.initials: R
authors.lastname: Garside
authors.forename: Chris
authors.initials: C
authors.lastname: Cooper
authors.forename: Nicky
authors.initials: N
authors.lastname: Britten
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D006801:Humans; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D006113:United Kingdom