{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T18:08:57Z","timestamp":1784052537038,"version":"3.55.0"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore the physician\u2013patient relationship among individuals with type 1 diabetes engaged in extreme endurance sports, highlighting dynamics of recognition, autonomy, and negotiation in care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Qualitative 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0353885","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T17:31:57Z","timestamp":1784050317000},"page":"e0353885","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Glycemic meritocracy, sport and care: Between lay expertise and medical recognition"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3796-6370","authenticated-orcid":true,"given":"Jean-Charles","family":"Vauthier","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Kabuth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"issue":"9","key":"pone.0353885.ref001","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1055\/s-2004-830561","article-title":"Continuous glucose monitoring in diabetic long distance runners","volume":"26","author":"E Cauza","year":"2005","journal-title":"Int J Sports Med"},{"issue":"2","key":"pone.0353885.ref002","doi-asserted-by":"crossref","DOI":"10.1111\/dme.14981","article-title":"Blood glucose response to running or cycling in individuals with type 1 diabetes: a systematic review and meta\u2010analysis","volume":"40","author":"ML Eckstein","year":"2022","journal-title":"Diabet Med"},{"key":"pone.0353885.ref003","doi-asserted-by":"crossref","first-page":"1013877","DOI":"10.3389\/fpsyg.2022.1013877","article-title":"Domesticating the condition: design lessons gained from a marathon on how to cope with barriers imposed by type 1 diabetes","volume":"13","author":"D Montt-Blanchard","year":"2022","journal-title":"Front Psychol"},{"issue":"12","key":"pone.0353885.ref004","article-title":"Chronic illness and extreme performance: type 1 diabetes in ultra-endurance","volume":"20","author":"J-C Vauthier","year":"2025","journal-title":"PLoS One"},{"issue":"3","key":"pone.0353885.ref005","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1057\/s41285-018-0081-6","article-title":"Patients\u2019 experiential knowledge and expertise in health care: a hybrid concept analysis","volume":"17","author":"EM Castro","year":"2018","journal-title":"Soc Theory Health"},{"key":"pone.0353885.ref006","first-page":"586","volume-title":"Client-centered therapy: its current practice, implications, and theory","author":"CR Rogers","year":"1951"},{"key":"pone.0353885.ref007","author":"S Barker","year":"2016"},{"key":"pone.0353885.ref008","doi-asserted-by":"crossref","DOI":"10.4324\/9781003070672","author":"J Tronto","year":"2020","journal-title":"Moral boundaries: a political argument for an ethic of care"},{"issue":"1","key":"pone.0353885.ref009","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3917\/rsi.132.0091","article-title":"Introduction \u00e0 la pens\u00e9e d\u2019Emmanuel Levinas. 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