Prediabetic categorisation: the making of a new person

Abstract

The increasing global prevalence of type 2 diabetes has given rise to numerous trials designed to preventing diabetes. Most of these trials focus on encouraging individuals, especially ‘high-risk’ individuals to make lifestyle changes to reduce their chance of developing diabetes. Based on group interviews with health care professionals and qualitative in-depth interviews with participants in a diabetes preventive intervention with a biomedical aim to reduce risk of diabetes, in this article I critically explore the transformative potential of the medical classification prediabetes. My analysis of these data was informed by Bourdieu’s theory of practice and his concept of habitus which he defined as ‘systems of durable, transposable dispositions, structured structures predisposed to function as structuring structures, that is, as principles which generate and organise practices and representations’. Health professionals especially doctors saw the categorisation of patients as prediabetic in biomedical terms as a technical exercise that made visible information that already existed. In contrast, I found that patients saw the categorisation as creating a more fundamental change, the making of a new ‘high-risk’ person who had to take action based on a dialectical interplay between freedom and constraint in their everyday life, to manage these risk factors. They defined themselves as having a medical condition, a ‘lifestyle disease’. For these individuals, the precise meaning of and potential course of action depended on context, for example being diagnosed with prediabetes, could lead to personal benefits for those who were able to lower their blood glucose level. However, for some, there were circumstances, such as genetics, age or race, which could be neither influenced nor controlled. In this article, I note that screening-based preventive interventions that fail to consider embodied social knowledge and lived experiences will not achieve their desired outcomes.