Original Research| Volume 8, ISSUE 3, P181-186, October 2014

Download started.


What's the worry with diabetes? Learning from the experiences of White European and South Asian people with a new diagnosis of diabetes

Published:December 23, 2013DOI:



      An exploration of diabetes diagnosis from the patient perspective is important for understanding inequalities in access and developing quality care through the diabetes care pathway.


      South Asian and White European patients over 16 years with a recent (<1 year) diagnosis of diabetes were recruited from 18 GP practices in three UK locations – Luton, West London and Leicester. A semi-structured qualitative interview was conducted with 47 patients, 28 South Asian and 19 White European. Interview transcripts were analysed thematically and comparisons made between the White and South Asian groups.


      People expressed a range of emotions at diagnosis. Although many participants were familiar with diabetes through family and friends and were undergoing monitoring for comorbidities, they were surprised and upset to be diagnosed. In contrast, a small number reported how they did not worry about their diabetes diagnosis and others highlighted the different public perceptions, which exist about the seriousness of diabetes in relation to a diagnosis of cancer.


      Attitudes to diagnosis of diabetes varied on an individual basis and not directly by ethnicity. Practitioners need to be adaptable to work with individuals in order to facilitate access and support diverse populations.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Primary Care Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Roderick P.
        • Raleigh V.
        • Hallam L.
        • Mallick N.
        The need and demand for renal replacement therapy in ethnic minorities in England.
        Journal of Epidemiology and Community Health. 1996; 50: 334-339
        • Burden A.
        • McNally P.
        • Feehally J.
        Increased incidence of end stage renal failure secondary to diabetes mellitus in Asian ethnic groups in the United Kingdom.
        Diabetic Medicine. 1992; 9: 641-645
        • Raleigh V.
        Diabetes and hypertension in Britain's ethnic minority communities: implications for the future of renal services.
        British Medical Journal. 1997; 314: 209-212
        • Johnson M.
        • Owen D.
        • Blackburn C.
        Black and Minority Ethnic Groups in England: The Second Health and Lifestyles Survey.
        Health Education Authority, London2000
        • Riste L.
        • Khan F.
        • Cruickshank K.
        High prevalence of type 2 diabetes in all ethnic groups, including Europeans, in a British inner city.
        Diabetes Care. 2001; 24: 1377-1383
        • Verma A.
        • Birger R.
        • Bhatt H.
        • Murray J.
        • Millett C.
        • Saxena S.
        • Banarsee R.
        • Gnani S.
        • Majeed A.
        Ethnic disparities in diabetes management: a 10-year population-based repeated cross-sectional study in UK primary care.
        Journal of Public Health. 2010; 32: 250-258
      1. D. Coleman, 2010 Projections of the Ethnic Minority Populations of the United Kingdom 2006–2056,

        • Wilkinson E.
        • Randhawa G.
        Concordance facilitates access in diabetes care – service provider perspectives of service improvement and cultural competency.
        Diabetic Medicine. 2012; 29: 1440-1446
      2. M. Gulliford, J. Figueroa-Munoz, M. Morgan, D. Hughes, B. Gibson, R. Beech, M. Hudson, What does ‘access to health care’ mean? Journal of Health Services Research and Policy 7 (2002) 186–188.

        • Culley L.
        • Dyson S.
        Introduction: sociology, ethnicity and nursing practice.
        Ethnicity and Nursing Practice. 0-333-75331-3 Palgrave, 2001
        • Betancourt J.
        • Green A.
        • Carrillo J.
        • Ananeh-Firempong O.
        Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and healthcare.
        Public Health Reports. 2003; 118: 293-302
      3. NICE Clinical Guidance 138 2012 Patient experience in adult NHS services: Improving the experience of care for people using adult NHS services,; National Collaborating Centre for Chronic Conditions.

      4. NICE Clinical Guideline 66 2008 Type 2 Diabetes: the management of Type 2 Diabetes,

        • Loveman E.
        • Cave C.
        • Green C.
        • Royle P.
        • Dunn N.
        • Waugh N.
        The clinical and cost effectiveness of patient education models for diabetes: a systematic review and economic evaluation.
        Health Technology Assessment. 2003; 7: 1-190
      5. Diabetes UK 2012 Diabetes in the UK: key statistics on diabetes,

        • Currie C.J.
        • Gale A.M.
        • Poole C.D.
        Estimation of primary care treatment costs and treatment efficacy for people with type 1 and type 2 diabetes in United Kingdom from 1997–2007.
        Diabetic Medicine. 2010; 27: 938-948
        • Randhawa G.
        Renal health and transplantation – a focus on ethnicity.
        Journal of Renal Care. 2012; 38: 109-114
        • UKPDS Group
        UK prospective diabetes study VIII: study design, progress and performance.
        Diabetologia. 1991; 34: 877-890
        • Harris M.
        • Klein R.
        • Welborn T.
        • Knuiman M.
        Onset of NIDDM occurs at least 4–7 years before clinical diagnosis.
        Diabetes Care. 1992; 15: 815-819
        • Department of Health
        National Service Framework for Diabetes: Standards.
        HMSO, London2001
      6. Department of Health 2002 National Service Framework for Diabetes Delivery Strategy,

        • Department of Health
        Care Planning in Diabetes.
        HMSO, London2006
        • Peel E.
        • Parry O.
        • Douglas M.
        • Lawton J.
        Diagnosis of type 2 diabetes: a qualitative analysis of patients’ emotional reactions and views about information provision.
        Patient Education and Counselling. 2004; 53: 269-275
      7. NHS Institute for Innovation and Improvement. Transforming patient experience: the essential guide – the policy framework,

        • Wilkinson E.
        • Randhawa G.
        • Rehman T.
        • Abubacker T.
        The impact of quality improvement initiatives on diabetes care among South Asian people.
        Diabetes and Primary Care. 2011; 13: 90-98
        • Wilkinson E.
        • Randhawa G.
        • Roderick P.
        • Rehman T.
        • Abubacker T.
        National primary care guidelines for England: impact on chronic kidney disease prevention in South Asian populations.
        Journal of Nephrology. 2012; 25: 661-671
        • Guest G.
        • Bunce A.
        • Johnson L.
        How many interviews are enough? An experiment with data saturation and variability.
        Field Methods. 2006; 18: 59-82
        • Pope C.
        • Ziebland S.
        • Mays N.
        Analysing qualitative data.
        British Medical Journal. 2000; 320: 114-116
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qualitative Research in Psychology. 2006; 3: 77-101
        • Ritchie J.
        • Lewis J.
        Qualitative Research Practice. A Guide for Social Science Students and Researchers.
        SAGE, London2008
        • Rooney L.
        • Bhopal R.
        • Halani L.
        • Levy M.
        • Partridge M.
        • Netuveli G.
        • Car J.
        • Griffiths C.
        • Atkinson J.
        • Lindsay G.
        • Sheikh A.
        Promoting recruitment of minority ethnic groups into research: qualitative study exploring the views of South Asian people with asthma.
        Journal of Public Health. 2011; 33: 604-615
        • Van den Donk M.
        • Sandaek A.
        • Borch-Johnsen K.
        • Laritzen T.
        • Simmons R.K.
        • Wareham N.J.
        • Griffen S.J.
        • Davies M.J.
        • Khunti K.
        • Rutten G.E.H.M.
        Screening for type 2 diabetes. Lessons from the ADDITION – Europe study.
        Diabetic Medicine. 2011; 28: 1416-1424
        • Eborall H.
        • Davies R.
        • Kinmouth A.L.
        • Griffin S.
        • Lawton J.
        Patients’ experiences of screening for type 2 diabetes: prospective qualitative study embedded in the ADDITION (Cambridge) randomised controlled trial.
        British Medical Journal. 2007; 335: 490
        • Atkin K: Healthcare and BrAsians
        Ali N. Kalra V.S. Sayyid S. A Postcolonial People: South Asians in Britain. Hurst & Company, London2006: 244-255
        • Gray L.J.
        • Khunti K.
        • Williams S.
        • Goldby S.
        • Troughton J.
        • Yates T.
        • Gray A.
        • Davies M.J.
        • for the Let's Prevent Collaborators
        Let's Prevent diabetes: study protocol for a cluster randomised controlled trial of an educational intervention in a multi-ethnic UK population with screen detected glucose regulation.
        Cardiovascular Diabetology. 2012; 11: 56
      8. DESMOND,