Diabetes is a chronic disease requiring daily self-management impacting over 37 million individuals in the United States. Those living with diabetes consistently work to maintain clinically acceptable blood glucose levels to prevent and delay long-term complications such as cardiovascular disease, nephropathy, neuropathy, and retinopathy. The length of time one has diabetes is associated with the development of these long-term complications at earlier ages. Therefore, type 1 diabetes (T1D) peak age of diagnosis of 10-14 years of age coupled with rising incidence of type 2 diabetes (T2D) in childhood, warrants greater focus on glycemic control influences in all age groups, but especially in those who are diagnosed at younger ages. Food and beverage choices are integral to daily self-management and ultimately blood glucose management. These choices are influenced by a host of factors including social media. Viewing health and nutrition posts on Instagram has been shown to be associated with greater body dissatisfaction and concerns with the development of disordered eating and subsequently elevated blood glucose levels. This study used a mixed methods approach that was first accomplished by completing a nutrition content analysis on 300 Instagram posts from two T1D-related hashtags to fully understand the type of Instagram users that post nutrition-related content and analyze the content being shared publicly for alignment with current diabetes nutrition recommendations. Descriptive statistics showed that the posts were created primarily by females, and persons with diabetes on a variety of topics with nearly half of all posts promoting a “diet”. Unfortunately, several potentially harmful diets such as the very low carbohydrate ketogenic diet and low carbohydrate diet were a key focus of Instagram posts. Next, social network analysis (SNA), both quantitative and qualitative, conducted on the T1D data set identified patterns of engagement of posts; networks among those engaging with the posts; and the themes of post comments. Engagement statistics for each post were analyzed using general linear modeling. Results demonstrated that Instagram posts related to nutrition education/food substation, food/beverage, and diabetes management were those with the greatest engagement. The qualitative analysis of comments highlighted six main themes within the posts including negative food relationships and overall support for others within this community. Finally, differences between the content analyses of nutrition-related T1D and T2D Instagram posts from four distinct diabetes associated hashtags were assessed. The descriptive statistics revealed differences between the types of Instagram post creators for the two groups with the T1D content creators mostly being persons with diabetes whereas the T2D content creators were primarily personal businesses. Differences in diets promoted between groups were analyzed using general linear models that showed the major contributor to promoting diets was the main theme of the post along with health information providers. This dissertation is the first to analyze nutrition-related content on Instagram within the diabetes online community, and hence groundbreaking. This research adds to the literature by elucidating the importance of incorporating social media as a component of healthcare assessments in addition to diabetes self-management education and support. Further, this research highlights the differences between the T1D and T2D nutrition-related Instagram communities relative to motivations for creating content and overall messages to better assist healthcare providers in addressing disease type (T1D vs T2D) specific factors that may contribute to development of long-term diabetes related complications.
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