The Experience of Managing Diet in Type 2 Diabetes Versus Coeliac Disease : Important Differences That influence Success

BackgroundType 2 diabetes has been linked to obesity, binge eating disorder and food addiction (5). It is often managed by diet and exercise. The importance of self-management in attaining and maintaining glycaemic control has been documented extensively (1, 2, and 4). Research suggests people with type 2 diabetes often find managing diet difficult (1, 4). We considered whether this difficulty simply reflects the challenge of altering diet and lifestyle per se, or whether there are some unique factors in type 2 diabetes related to the addictive phenotype.AimsThe aim of this study was to compare the experience of managing diet in type 2 diabetes with that of another diet managed condition (coeliac disease) that has not been associated with an addictive phenotype. We predicted there would be some similarities, but also some significant differences between these groups.MethodParticipants (n = 461) were recruited through social media, local support groups and Prolific, which is a participant recruitment tool (University of Oxford). Self-report questionnaire measures of food addiction and self-control were analysed for group differences alongside measures of mood, subclinical diabetes-related distress, and health perceptions.ResultsBoth groups reported that thinking about their health made them feel depressed and both groups reported making clearer decisions about what and how much they eat after being diagnosed with their condition. People with type 2 diabetes, however, reported more often overeating, and more often feeling upset when this occurred. The type 2 diabetes group also reported perceiving more negative thoughts and beliefs about food/eating compared to the coeliac disease group, and they reported feeling like life was less rewarding overall. Enjoyment of a favourite meal showed a much greater change after diagnosis in the type 2 diabetes group. Finally, the coeliac disease group reported much greater anxiety around attending social situations involving food intake.DiscussionResults suggest that being diagnosed with a long-term diet managed condition has a negative psychological impact, as would be expected. But there are important differences in these conditions. Overeating and feeling upset as a result is much greater in people with type 2 diabetes. In addition, this group appear to suffer negative mood linked to the loss of food as a u2018rewardu2019 in life. These findings are characteristic of an addictive phenotype. In contrast people with coeliac disease reported much higher social anxiety, most likely linked to a fear of being u2018glutenedu2019. Our results therefore suggest that self-control and the relationship with food is very different in these two diet managed conditions. These findings are confirmed by qualitative work in our sister study and suggest that an improved understanding of the psychology underlying these conditions has the potential to impact on the design of care and intervention for successful outcomes.References1. Fisher, L. et al. (2008) u2018A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetesu2019, Diabetic Medicine. Blackwell Publishing Ltd, 25(9), pp. 1096u20131101. doi: 10.1111/j.1464-5491.2008.02533.x.2. National Institute for Clinical Excellence (NICE) (2017) u2018Type 2 diabetes in adults: management ' Guidance and guidelines ' NICEu2019, NICE Guidelines. NICE. Available at: https://www.nice.org.uk/guidance/ng28 (Accessed: 14 February 2019).3. Polonsky, W. H. et al. (2005) u2018Assessing psychosocial distress in diabetes: Development of the Diabetes Distress Scaleu2019, Diabetes Care, 28(3), pp. 626u2013631. doi: 10.2337/diacare.28.3.626.4. RS, M. et al. (2005) u2018Mood and psychotic disorders and type 2 diabetes: A metabolic triadu2019, Canadian Journal of Diabetes, 29(2), pp. 122u2013132.5. World Health Organization (2016) u2018Global Report on Diabetesu2019, Isbn, 978, p. 88. doi: ISBN 978 92 4 156525 7.

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