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Association between breastfeeding and insulin sensitivity among young people with Type 1 and Type 2 diabetes: the SEARCH Nutrition Ancillary Study
Author(s) -
The N. S.,
Shay C. M.,
Lamichhane A. P.,
Crume T. L.,
Crandell J. L.,
Wang S.,
Dabelea D.,
Lawrence J. M.,
MayerDavis E. J.
Publication year - 2016
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13112
Subject(s) - medicine , breastfeeding , type 2 diabetes , association (psychology) , insulin sensitivity , insulin , type 1 diabetes , medline , diabetes mellitus , gerontology , pediatrics , insulin resistance , endocrinology , philosophy , epistemology , political science , law
(n = 10); and (2) diagnostic test numbers were borderline (n = 10). Four women expressed concern with the new diagnostic test (2–h 75 g oral glucose tolerance test). Four women felt they did not fit the typical gestational diabetes profile (not overweight, healthy diet). Nearly one in four women perceived misdiagnosis with gestational diabetes. The high prevalence of perceived misdiagnosis in our study is surprising as misdiagnosis has been infrequently mentioned in prior studies. To our knowledge, only one prior qualitative study described women’s scepticism about their diagnosis, with 9% of the 393 Australian participants spontaneously describing uncertainty or scepticism about their diagnosis [4]. Similar to our study, these women also based their beliefs on borderline test results and easy management of the disease [4]. It is possible that other studies may not have elicited perceptions of misdiagnosis due to women’s hesitancy to spontaneously raise concerns about misdiagnosis. Thus, detection of perceived misdiagnosis may require a very large sample size or use of proactive questioning. This study has several limitations. First, the positive phrasing of the question used to detect perceived misdiagnosis might have contributed to overestimation of perceived misdiagnosis. However, inclusion of a follow-up question requiring an explanation for this perception should allow confirmation of the belief and minimize suggestion bias [7]. Second, our sample was well-educated; findings may differ in less-educated populations. Third, our sample size was not large enough to identify potential differences by sociodemographic characteristics or by clinic site. Although the patient sample contributed by each individual clinic was small, our results are strengthened by the consistency with which perceived misdiagnosis was detected across study sites, racial/ethnic groups and education levels. Although the downstream ramifications of perceived misdiagnosis were not assessed in this study, studies in other disease areas have suggested that patients perceiving misdiagnosis may feel less trust in their physician [8] and may be less likely to adhere with recommended treatment [2]. Given the potential for these adverse effects, healthcare providers caring for women with gestational diabetes should consider proactively assessing for and addressing concerns for perceived misdiagnosis.