Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




The rising incidence of diabetes mellitus (types 1 and 2) transcends national borders, creating a global pandemic. The U.S. leads the world in diabetes prevalence, despite its wealth and access to sophisticated medical technologies. Within health care, there is an increasing focus on lifestyle and behavioral interventions that research suggests may be the key to reversing this trend, but thus far their effectiveness in practice is uneven at best. In order to gain a better understanding of the other factors involved in professional diabetes care work that might support or inhibit effective diabetes management, this research treats diabetes as a social problem and investigates the question, "How is diabetes care done?"

This institutional ethnography is centered on frontline diabetes care workers, primarily from the standpoint of diabetes educators. I draw on data from in-depth interviews with 30 diabetes care workers in 2012 and approximately 150 hours of participant observation of professional associations, annual meetings, local networking events, and educational events conducted between 2012 and 2014. I also analyze the ways that texts coordinate their activities and provide context for them. Viewed through a negotiated care framework, the data show that diabetes care workers negotiate amongst themselves and other stakeholders to define professional diabetes care as it is practiced within the constraints of policy.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.