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Couple intervention improves HbA1c in type 2 diabetes
Significant, lasting improvements in HbA1c levels, obesity measures and some psychosocial outcomes were found with a collaborative couples’ intervention in adults with poorly controlled type 2 diabetes.
“For patients with type 2 diabetes in poor glycemic control, it can be beneficial to involve their partners in diabetes self-management education, working toward establishing a collaborative approach to managing diabetes, to establish better control and modest improvements in aspects of quality of life,” Paula M. Trief, PhD, professor of psychiatry and behavioral sciences, professor of medicine and clinical professor of orthopedic surgery and senior associate dean for faculty affairs and faculty development at SUNY Upstate Medical University in Syracuse, New York, told Endocrine Today.
Paula M. Trief
Trief and colleagues evaluated data from the Diabetes Support Project on 280 couples, among whom one had type 2 diabetes (HbA1c 7.5%), to compare glycemic control and secondary outcomes of a 4-month telephonic couples’ behavioral intervention with individual intervention, and with education. Participants were randomly assigned to one of three arms: couple calls (n = 104), individual calls (n = 94) and diabetes education (n = 82). Two self-management education calls occurred in all groups; the couple calls and individual calls group received 10 additional calls.
All groups had significant reductions in mean HbA1c (couple calls, –0.47%; individuals calls, –0.52%; diabetes education, –0.57%). Evaluation of the bottom HbA1c tertile (7.5%-8.2%) revealed that there were no significant differences between the groups from baseline. The couple calls group had significantly lower HbA1c compared with the other groups at every follow-up when the middle tertile (8.3%-9.2%) was evaluated. Significant reductions in HbA1c at every follow-up were found for the top tertile ( 9.3%).
There were no significant differences in mean BMI and mean waist circumference at any follow-up between the groups.
The individual calls group had lower mean systolic blood pressure (P = .021) and mean diastolic BP (P = .032) compared with the diabetes education group at 8 months. Mean diabetes distress was lower in the couple calls group compared with the diabetes education group at 12 months (P = .009) and 8 months (P = .057). Mean diabetes self-efficacy was marginally greater in the couple calls group compared with the diabetes education group (P = .058) at 4 months; no other group differences were found. Mean depressive symptoms did not differ between the groups.
“For type 2 diabetes patients with moderately poor control, clinicians should consider inviting partners to participate in clinical appointments and education sessions, so that the influence they inevitably do have on the patient can result in longer lasting positive changes,” Trief told Endocrine Today. “For patients who have very poor glycemic control, education is valuable to help them improve their control and, while involving the partner does not appear to provide added benefit, it may be beneficial in unmeasured ways and does not appear to be harmful (ie, does not lead to more distress or conflict).” – by Amber Cox
For more information:
Paula M. Trief, PhD, can be reached at triefp@upstate.edu.
Disclosure: Trief reports no relevant financial disclosures.