management of type 2 diabetes Shane O'Donnell PhD candidate UCD - - PowerPoint PPT Presentation

Scoil na Socheolaíochta UCD Áras Newman , Belfield, Baile Atha Cliath 4 sociology@ucd.ie www.ucd.ie/sociology UCD School of Sociology Newman Building Belfield, Dublin 4 T +353 1 716 8510 F +353 1 716 1125

Walking a Tight Rope: social class differences in the everyday management of type 2 diabetes Shane O'Donnell PhD candidate

“Diabetes in crisis?”

What is type 2 diabetes?

• Characterised by inability to control glucose

– Body has become insulin resistant

• Diagnosed in later life
• Obesity
• Managed though exercise, diet and medication
• Complications: Nerve damage ,blindness, kidney

Failure, stroke

Diabetes in Ireland

• 4.5% of the Irish Population diagnosed.
• State spends 350m every year on diabetic

related interventions

• 60% of government funding is spent on

preventable complications

Discourse surrounding diabetes epidemic so far…

• “Disease of lifestyle”
• high carb diet, increasingly sedentary

“(N1):There is this caricature or stereotype of an

• bese slob who deserves no attention for their

multiple medical disorders.... Why isn't there an adequate prevention program for obesity and diabetes? Its because the medical profession, the policy makers and society as a whole see it as broadly their own fault...The obese person is subject to enormous discrimination”

Social Class and Diabetes

• mortality 230 % greater in lowest

socioeconomic groups compared to highest

– poverty features in only 23 articles out of a total of 3000 articles in diabetes causation and management literature. (chuafan: 2004)

Education and Diabetes

• Strong evidence from RCT’s and systematic

reviews that education interventions are valuable

– Diabetes self management education promotes adherence to regimen and improve quality of life – Results vary across different social contexts – Social groups most in need least likely to derive benefit

Inequality, stress and diabetes – Wilkinson’s Psychosocial Model

• Contemporary health affected through social

position embedded in hierarchical structure of society

• Stress derived from low social status
• Greater levels of inequality = higher rates of

illness, phychological distress and other social problems

• Encourages competition, weakens social cohesion
• Flee or fight response

Psychosocial framework: Diabetes management and control

Direct impact Lower social status Chronic stress Insulin resistance Sub-optimum glucose control Indirect impact Lower sense of self worth Alcoholism, substance abuse, comfort eating Sub-optimum glucose control

Social Status, Stress and the workplace

• Stress derives from three main areas : early

childhood experiences, relationships with significant others, the workplace.

• Whitehall study involving over 10,000 civil

servants (Marmot et al: 2004)

• Health declines in stepwise gradient the further

the individual is from top of civil service rank.

• Could not be explained by conventional risk

factors like diet and lack of exercise

• Stress due to lack of control and authority

decision making was shown to be key factor.

Relative Rates of cardiovascular disease in Whitehall

• In sum, Low control at work=
• higher levels of depression
• Sleep loss
• increased insulin resistance/Hba1c
• higher cholesterol

Life course studies and diabetes

• Wide range of longitudinal studies and meta

analysis shows links between low SES in childhood, especially in women

• Accumulation of stressful life events and low

social support linked to worse glucose outcomes

• Depression “the great undiagnosed complication
• f diabetes” 40% more at risk CVD

Lack of control over ones life = lack of control over one’s blood sugars

• Stress and managing type II diabetes is a disaster. So if you

have financial worries; about relationship with your partner; about keeping a job that will always come ahead of keeping a track on how your sugars are doing, how you are complying with your going out for three walks a day how you are complying with taking your medication. We would see all the time a person who has reasonable control... something goes on in their life and their sugar goes off. So it is a disaster for managing a chronic illness (-endocrinologist

• People who are poorly managing their diabetes I would say

a large amount of them are suffering from depression… although I wouldn’t call it depression because depression means its kind of treatable …its think its just a low level of self esteem… Now I wonder… is that a normal reaction to events that you don’t wont to be there (G.P)

• To explore social class differences in the everyday

experiences of living with type 2 diabetes

• Interview both lower and higher socioeconomic

groups.

• Qualitative semi structured interviews

Thank you for your time

Bibliography

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