How diabetic patients think about and manage their illness in Taiwan

Type 2 diabetes is becoming more prevalent in Taiwan. Growing evidence suggests a patient-centred approach is more effective in facilitating self-management than a professional-centred one. The aim of this qualitative study was to investigate Chinese diabetic patients' perceptions about their illness and treatment strategies to facilitate patient-centred, culture-sensitive clinical skills.

We used in-depth interviews to collect perspectives from 22 participants recruited from a rural Taiwan community. All interviews were audio-taped and the transcripts were analysed by editing and immersion/crystallization. Emerging themes were compared with current medical knowledge to determine their clinical significance.

Generally, Chinese diabetic patients had variable perceptions about different treatment strategies. All agreed that dietary restriction and exercise were beneficial. The former, mainly understood as reducing carbohydrate intake, was thought to be most important; exercise, to the point of sweating, was seen as a way to eliminate pharmaceutical toxins. Taking medicine was regarded with ambivalent attitudes due to concerns about adverse effects (especially renal injury).

Patients regarded all treatment strategies as integrative and intertwined in daily life. There are three misconceptions which we found should be clarified during medical consultations: (i) focusing on sugar-control only; (ii) benefit of sweating to eliminate toxins; (iii) fear of renal toxicity of hypoglycaemic agents. The renaming of diabetes, to such as 'metabolic syndrome', may bring new, acceptable insight to Chinese diabetic patients.