ArticlePloS one2026
Glycemic meritocracy, sport and care: Between lay expertise and medical recognition.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo explore the physician-patient relationship among individuals with type 1 diabetes engaged in extreme endurance sports, highlighting dynamics of recognition, autonomy, and negotiation in care.
methodsQualitative study based on thirteen semi-structured interviews with French-speaking runners living with type 1 diabetes. Analysis followed a constructivist grounded theory approach, with inductive coding and triangulation.
resultsThe findings reveal a complex relational dynamic structured by gaps in medical expertise, the emergence of experiential autonomy, evolving forms of collaboration, and persistent structural constraints. These dynamics reflect a tension between standardized biomedical knowledge and situated, experience-based practices. Recognition of patient expertise appears conditional, often depending on the ability to maintain acceptable glycemic outcomes.
conclusionThis study identifies an implicit model, termed glycemic meritocracy, in which patient autonomy and legitimacy are shaped by conformity to biomedical norms. These findings highlight the need to move beyond performance-based evaluations of care and to more fully integrate experiential knowledge into clinical practice, particularly in complex or atypical contexts.
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