title: Experiences of food abstinence in patients with type 2 diabetes: a qualitative study.
abstract: OBJECTIVE
  People with type 2 diabetes often report pressure to abstain from many of life's pleasures. We tried to reconstruct these patients' sense of pressure to better understand how people with diabetes make sense of, and integrate, these feelings into their life.
  
  
  METHODS
  A secondary analysis of narrative interviews with 14 patients with type 2 diabetes who are part of a website project.
  
  
  METHODS
  Grounded theory-based analysis of narrative interviews, consisting of open, axial and selective coding.
  
  
  RESULTS
  People with type 2 diabetes felt obliged to give up many pleasures and live a life of abstinence. They perceived a pressure to display a modest culinary lifestyle via improved laboratory test results and weight. Their verbal efforts to reassure and distance themselves from excessiveness indicate a high moral pressure. With regard to the question of how to abstain, food and behaviour were classified into healthy and unhealthy. Personal rules sometimes led to surprising experiences of freedom.
  
  
  CONCLUSIONS
  People with diabetes have internalised that their behaviour is a barrier to successful treatment. They experience an intensive pressure to show abstinence and feel misjudged when their efforts have no visible effect. Taking into account this moral pressure, and listening to patients' personal efforts and strategies to establish healthy behaviours, might help to build a trusting relationship with healthcare providers.
authors.affiliation: Department of General Practice, University Medical Center, Göttingen, Germany.
authors.forename: Maike
authors.initials: M
authors.lastname: Buchmann
authors.affiliation: Department of General Practice, University Medical Center, Göttingen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Wermeling
authors.affiliation: Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Lucius-Hoene
authors.affiliation: Department of General Practice, University Medical Center, Göttingen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Himmel
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy*; D004032:Diet / Q000379:methods* / Q000523:psychology; D005260:Female; D005518:Food Preferences / Q000523:psychology*; D066296:Grounded Theory; D015438:Health Behavior; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012648:Self Care
keywords: Diabetes mellitus, type 2; Moral obligations; Narrative medicine; QUALITATIVE RESEARCH