Controlling diabetes, controlling diabetics: moral language in the management of diabetes type 2 (original) (raw)
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This article is based on original ethnographic research among college students aged 18–25 living with insulin-dependent type 1 diabetes. I investigate how moral language in medical treatment settings and social environments informs patients’ experiences of managing their diabetes. Moral language about choice, control, responsibility, and risk was regularly used to describe daily diabetes management habits. Young adults with diabetes internalized a moral imperative to prioritize health. This moral obligation to health contributed to participants’ conceptions of self and influenced participants’ characterizations of other people with diabetes (PWD). Since the mid-twentieth century, the clinical approach to diabetes care has relaxed; however, some harmful assumptions linking patient character to his or her ability to comply with a prescribed treatment regimen still circulate in the culture of type 1 diabetes care. While failing to take insulin or to check blood sugars can lead to dangerously high or low glucose levels in the body, language tying patient worth to treatment compliance fails to show the complexity of striking a balance between hypervigilance and negligence in daily diabetes care rou- tines.
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Patients experience considerable difficulties in making and sustaining health-related lifestyle changes. Many Type 2 diabetes patients struggle to follow disease risk-management advice even when they receive extensive information and support. Drawing on a qualitative study of patients with Type 2 diabetes, the paper uses discourse analysis to examine their accounts about disease causation and disease management, and the implications for how they respond to their condition and health services advice. As it is a multifactorial disease, biomedical discourse around Type 2 diabetes is complex. Patients are encouraged to grasp the complicated message that both cause and medical outcomes related to their condition are partly, but not wholly, within their control. Discursive constructions identified from respondent accounts indicate how these two messages are deployed variously by respondents when accounting for disease causation and management. While these constructions (identified in respondent accounts as ‘Up to me’ and ‘Down to them’) are a valuable resource for patients, equally they may be deployed ina selective and detrimental way. We conclude that clear messages from health professionals about effective disease management may help patients to position themselves more effectively in relation to their condition. More importantly, they might serve to hinder the availability of inappropriate and potentially harmful patient positions where patients either relinquish responsibility for disease management or reject all input from health professionals.
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Through an ethnographic engagement with the technosocial situations of diabetes care in Japan, this paper explores two ways in which the metabolism is acted upon: learning and patient advocacy. 1 The fi rst section introduces a diabetes clinic where patients are treated for the prevention of diabetic complications. Metabolism, here, comes in an organizational form, as a diet regimen (shokuji ryōhō) that has to be mastered during the two weeks of hospitalization. The second section, by contrast, follows food as it is mediated through the collective activities of a patient group in a Tokyo neighborhood.
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The disproportionate prevalence of Type II diabetes mellitus among the poor sug- gests that, in addition to lifestyle factors, social suffering may be embodied in diabetes. In this article, we examine the role of social distress in narratives collected from 26 Mexican Americans seeking diabetes care at a public hospital in Chicago. By linking social suffering with diabetes causality, we argue that our participants use diabetes much like an “idiom of distress,” leveraging somatic symptoms to dis- close psychological distress. We argue that diabetes figures both as an expression and a product of social suffering in these narratives. We propose that increasingly prevalent chronic diseases, like diabetes, which are closely associated with social disparities in health, may function as idioms for psychological and social suffer- ing. Such findings inform the anthropological literature and emerging clinical and scientific discourse about the roles of stress and psychological distress in di...
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Type 2 diabetes is a metabolic disorder characterised by chronically elevated blood glucose and a high risk of cardiovascular and other complications. Self-management is central to diabetes care and includes taking regular exercise, low-fat/sugar diet and blood glucose monitoring. However, little is understood about how people with diabetes make sense of self-management. Our aim, therefore, is to explore the process of ‘getting one's thoughts straight’ in relation to illness self-management for women with poorly controlled type 2 diabetes. Eight women were recruited from two hospitals in the North of England. Each was interviewed using a biographic-narrative method. Narratives were analysed using a dialogical approach. We use Bakhtin's concepts of voice, official and unofficial truth, and internally persuasive discourse to explore how participants considered, struggled with, and, sometimes, acted upon self-management. We demonstrate how the truth by which participants lived shifted as they encountered new perspectives and experiences. The accounts revealed tension between official, authoritative voices, typically concerned with optimal illness control and unofficial voices that speak at a lived, embodied level. In conclusion, we suggest moving beyond the notion of self-management towards a conceptualisation of life with chronic illness that includes personal goals, values and embodied experience in context.
FMDB Transactions on Sustainable Health Science Letters, 2023
The primary goal of this article is to explore whether there are any specific ethical issues raised by public health interventions to prevent diabetes. Diabetes is invoking an increasingly high disease burden on global health and becoming a critical threat to economic and social development worldwide. This paper starts with a general idea and types of diabetes. Then it exhibits some reports which show clear evidence that diabetes is currently a worldwide threat to public health. After that, this paper dedicates to exploring the novel ethical dilemmas raised by the preventive public health measures for diabetes. This work also highlights that incorporating bioethical principles such as justice, beneficence, non-maleficence, and autonomy are missing in the prevention methods of diabetes. Here it attempts to point out that without resolving the ethical dilemmas, preventive health programs are not worth effective implantation and consequently fail to provide people with a healthy life. It also categorizes some ethical distinctions of diabetes as a non-communicable disease with infectious disease ethics. Finally, it critically analyses the adopted public health standards to consider whether these raise any specific ethical dilemmas. This paper concludes with some suggestions to resolve these dilemmas.
“THE ETHICS OF RESPONSIBILITY IN THE PUBLIC HEALTH FOR THE CARE OF DIABETIC PATIENTS (PART II)”
METHODOLOGY The Social Clinical observation will be the methodological route, in addition to the anthropological and philosophical theoretical analysis delimited by the theoretical-conceptual framework. The in-depth interview was given to all the participants of this study (23). The goal of the interview was to discover the opinion and perception of the patient (key actor), from the macro and micro visions and to know in depth the causes of failure in their metabolic control. RESULTS Patients had significant improvement in terms of the indicators by 82.6%. In general terms, the fulfillment of the four planned goals was reached in 73.91 %. The patients had 4.95 times major possibility of controlling their glucose, 5.33 times major possibility of diminishing their cardiovascular risk, 3.04 times of reducing their weight and 6.85 times of reducing their Hb1Ac. Severely uncontrolled patients who are submitted to strict control under the hybrid attention model by a multidisciplinary brigade, which is sensitive to the anthropological and social aspects in addition to the technical questions, will have 5.04 times major possibility of improving these four aspects and hence their health and risk situation, than those who are treated by the traditional vertical model divided into the first and second existing levels in the National Health Services. CONCLUSIONS In terms of Population Attributable Risk, this involves a possibility of potential progress of 19.04 % in similar populations, if the model developed in this work is continued in the shape of a permanent program of intra-institutional coordination and multilevel. KEYWORDS: Ethics of the Responsibility, Public Health, Diabetes Mellitus.