Endocrine Abstracts

Introduction: To date, psychological research on pancreatic transplantation has focused mainly on illness and quality of life. Research has been predominantly quantitative rendering it impossible to identify specific psychological issues faced by patients. Uniquely, this work considered post-transplant issues in the context of the pre-transplant psychological burden of patients with T1DM.

Methods: 21 individuals with T1DM were interviewed (11 males; five pre-transplant, 16 post-transplant). Time since transplantation varied from 7 weeks to 3 years. Individual semi-structured interviews were digitally recorded, transcribed verbatim and analysed independently by two researchers using inductive thematic analysis.

Results: ‘Diabetic identity’ was a key theme. Failure to maintain good blood glucose levels despite participants’ best efforts led many to ‘give up’ taking on a ‘Failed patient’ identity. Contact with some healthcare services reinforced the sense of failure. The shame associated with the need for help from third parties (e.g. family and work colleagues) to deal with the resultant hypos meant some participants ‘felt like second class citizens’. Post-transplantation although they believed their identity to be ‘still diabetic’, some participants aspired to the identity of a successful transplant patient. This desire tended to manifest in competitive behaviour with possible adverse results on recovery, i.e. leaving hospital too soon, taking on too much at home, and returning to work too soon. These behaviours were associated with health-related problems.

Conclusions: Having a functioning pancreas, and being symptom-free, did not negate the experience and identity of having T1DM. Wanting to be rid of the sense of failure associated with having diabetes led some participants to make ill-advised decisions post transplant. If not recognised and managed appropriately, these behaviours could result in adverse health outcomes following transplantation, resulting in more frequent clinic attendance and delayed return to full activities of daily living, including delayed return to work.