June 14, 2012

Family members can often sabotage diabetes care: study

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Family members can often sabotage diabetes care: study

Nonsupportive family members contribute to adults with diabetes having poor medication adherence and glycemic control, a new Vanderbilt study shows.

The study, published in Diabetes Care, found that family members perform sabotaging behaviors such as not packing diet sodas for the family picnic, for example, or tempting loved ones with unhealthy food from their favorite restaurant.

Study authors Lindsay Mayberry, a doctoral student at Vanderbilt Peabody College, and Chandra Osborn, Ph.D., MPH, assistant professor of Medicine and Biomedical Informatics, conducted focus group sessions with 45 adults with type 2 diabetes and a survey with 61 adults with type 2 diabetes.

Perceiving that family members were knowledgeable about diabetes was associated with perceiving that family members performed more diabetes-specific supportive behaviors, according to the study.

“It is not necessarily emotional support that they want, but we find the key is that really tangible kind of ‘get in the trenches with me and help me figure this out’ support. Pieces of the environment communicate to someone with diabetes that my family members are supporting me in this,” Osborn said.

Examples of helpful support mentioned by participants in the study, Osborn said, included very tangible things that people could do such as reminding loved ones to take their medicine when they go out to eat, or reading food labels together in the grocery store.

“One of the things that was mentioned a lot was wives carrying snacks in their purses for their husbands in case they had a response to their medication where they felt shaky or weak,” Mayberry said.

“Also, people would carry an extra medication dose in their purses or briefcases, so if the patient forgot to bring their medication then the family member had it with them. Those are very tangible things that people could do on a regular basis.”

Perceiving that family members performed nonsupportive behaviors was associated with being less adherent to diabetes medication regimens, which correlated with worse glycemic control, according to the study.

“We learned that family support, which has been typically a critical part of diabetes research for children and adolescents, might be more critical among adults than we previously thought,” Mayberry said. “What we found is that when family members performed more nonsupportive behaviors, patients were less adherent to their medications, and that had an effect on their clinical outcomes.”

“Someone in the focus group commented on that: ‘I went to a picnic, my family knows that I have diabetes and a lot of my family members have diabetes, and no one brought the Diet Coke,’” Osborn said. “And that’s a very strong message to someone with diabetes.”

Researchers found two areas of nonsupportive behaviors – “sabotaging” and “miscarried help.”

“Sabotaging behaviors was a term that came from the participants who would say ‘My husband sabotages my diet by doing things like trying to make me eat cookies’ and things like that,’” Mayberry said. “We heard people say ‘family members will go to my favorite restaurant even though they know that when I go there I can’t maintain my healthy diet.’

“And then we had what we called ‘miscarried help,’ which is something that has been found in adolescents with diabetes where family members sort of nag the patient and infringe upon their self-efficacy by saying ‘you need to do this’ and so the person, in a way, rebels.”

Osborn noted that these findings emerged as part of a larger project focusing on technology use and diabetes management.

“This is really a finding we weren’t expecting,” Osborn said. “The goal of the study was to have patients talk about how they are using technology to manage their diabetes, so we were really interested in a completely different topic. They sort of spontaneously talked about their family a lot. It really wasn’t our primary focus, but clearly it was important to them and it emerged from the data.”