Background: Individuals living with complex diabetes in medically underserved areas face additional barriers to accessing needed services and support. This study used photo elicitation interviews (PEI) to develop a rich understanding of everyday life among individuals with complex diabetes living in such areas of New Mexico (NM).

Methods: Five individuals with T1DM and 3 with complex T2DM receiving care through Endo ECHO in NM received digital cameras and the task of taking photographs about their experience of living with diabetes, and then participated in interviews with our team, during which they selected 10 photos from their collections to discuss. Interviews were recorded and transcribed, and then coded using Grounded Theory in an iterative process.

Results: Six family-codes emerged: Self-management, health care, support, complications, food, and coping strategies. Three overarching axial codes were identified: Rural living, body self-knowledge, and diabetes burden. A picture of the relentless and never-ending nature of managing diabetes emerged in the analysis. Over half of the photos were of food, both healthy and forbidden; food is an overriding concern, and participants’ understanding of healthy food varied greatly. Participants noted important sources of support and optimism, and the joy of activities beyond diabetes care such as online gaming, raising chickens, or hiking.

Conclusions: Participants shared their unique perspectives; however, regardless of participants’ age, diabetes diagnosis, and gender, they uniformly expressed acute awareness of the permanent burden of their condition, the challenges of self-management, and the need to overcome the barriers of living in medically underserved areas. PEI proved to be a valuable method for ascertaining a deep understanding of individuals’ daily experience of living with complex diabetes.


M.M. Paul: None. A. Davila Saad: None. M. Tagliaferro: None. J. Billings: None. S. Blecker: Advisory Panel; Self; Medtronic. C. Berry: None.


The Leona M. and Harry B. Helmsley Charitable Trust

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