Diabetes as part of growing up

MEDICS are turning to anthropologists to help them understand the lifestyles and attitudes of young diabetics across Europe.

David Riches and Alexandra Greene of St Andrews University, and Stephen Greene and Ray Newton of Ninewells Hosptial, Dundee, aim to set the understanding and treatment of diabetic adolescents in a social and cultural context.

"Diabetes is a chronic and lifelong condition, submitting diabetics to strict insulin, diet and exercise routines which are often at odds with the lifestyle and images prevalent in youth culture today," Dr Riches said.

"We are seeking to improve the communication between young diabetics and the healthcare professionals."

The work has focused on the interaction between medical professionals and young patients in various types of paediatric clinics, and in particular on the strategies used to bridge the cultural gap between professional, middle-class doctors and young working-class patients. The researchers have focused on those clinics where medical professionals establish quasi-family relationships with young patients, disguising the authoritarian relationships which prevail between doctor and patient. Various cities use the same medical techniques, but the response of the diabetics varies.

"We have found that those clinics where distinctions between professionals - for example, consultants, dieticians and nurses - are played down, prove the most effective," Dr Riches said. "But while it is a good idea to create an atmosphere of a happy family, which includes the young diabetics as members, we have found that the strategy has to be subtle. It seems that although the consultants may wear casual clothes in the clinic, the young people appreciate that they do still represent an authority figure."

So far, the investigators have concentrated their study on five clinics and about 50 patients in Scotland, using in-depth interviews. They are about to broaden their enquiries and hope to gain similar success in European cities.