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Interventions for couples yield benefits for partners of adults with type 2 diabetes
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Adults with type 2 diabetes and their partners may achieve greater relationship satisfaction and less diabetes distress when participating in collaborative couples intervention, according to findings published in Diabetic Medicine.
“Diabetes requires that the person with diabetes make significant behavioral changes that are likely to impact family members,” Paula Trief, PhD, professor of psychiatry and behavioral sciences, medicine and orthopedic surgery at SUNY Upstate Medical University in Syracuse, New York, and colleagues wrote. “Interdependence theory posits that partners should provide mutual support for behavior change and use collaborative problem-solving techniques to help persons with diabetes make changes. This interdependence supports the potential value of couples interventions for change in the partner as well as in the person with diabetes.”
Trief and colleagues utilized data from the Diabetes Support Project, which was a 12-month, randomized controlled trial that assessed the efficacy of couples intervention compared with individual intervention and diabetes education alone.
The researchers randomly assigned 268 couples, defined as two adults in a committed relationship of 1 year or more in which one partner had type 2 diabetes, to couples intervention, individual intervention or diabetes education alone. The mean age of partners of participants with diabetes was 55.8 years, and 64.6% were women. In the diabetes education group, only the partner with diabetes received two diabetes education calls. In the individual intervention, partners with diabetes received the two diabetes education calls as well as 10 additional calls over 12 weeks. The couples intervention group received the same number of calls as the individual intervention group, but with both partners participating.
The researchers were focused on outcomes for the partners of participants with diabetes. These outcomes included obesity, blood pressure, diabetes distress as measured by a modified Problem Areas in Diabetes questionnaire, depressive symptoms and marital/relationship satisfaction. They also evaluated behavior changes, such as fat intake and physical activity. Outcomes were measured at 4, 8 and 12 months.
Partners of participants with diabetes in the couples intervention group had lower diastolic BP at all three time points compared with the diabetes education group (P < .005) and at 12 months compared with the individual intervention group (P = .007). Diabetes distress was also lower for partners of participants with diabetes in the couples intervention group compared with both individual and diabetes education interventions at 4 and 8 months (P < .001) as well as 12 months (P < .05).
Relationship satisfaction was more varied during the 12 months of the trial. Partners of participants with diabetes in the couples intervention group had higher relationship satisfaction scores than those in the diabetes education arm at 4 months (P = .005) and 8 months (P = .009), but not at 12 months. The only difference between the couples and individual intervention groups was found at 8 months, when the former had a higher score (P = .043).
In terms of behavioral changes, the researchers noted that partners of participants with diabetes in the couples intervention group had higher physical activity levels at 4 months and 8 months (P = .015), but not at 12 months. In addition, no significant differences were found in fat intake among the three groups.
“Our data indicate that involving the partner in an intervention may have beneficial emotional and relational effects on the partner, at least when the intervention is focused on promoting collaboration, communal coping and emotional openness,” the researchers wrote. – by Phil Neuffer
Disclosures: Trief reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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The literature is rich in evidence related to support for individuals with chronic disease and how support can help improve clinical and behavioral outcomes. Diabetes educators are well aware of the positive effects of support; they have the opportunity of working very close with individuals and their families for extended periods of time and develop a trusting working relationship. They help facilitate collaborative goal setting with one or more self-management interventions and educators are experts in connecting individuals to critical resources such as online or F2F support groups, other health care professionals such as social workers and counselors as well as financial support resources through community or prescription assistance programs.
There is a powerful family component that exists since you cannot separate diabetes from the family. Open communication and positive reinforcement can help the individual engage and embrace certain behavior change strategies, especially those related to healthy eating and physical activity. The more supportive other people are and the more they are educated about how to intervene with positive reinforcement, the better they are at helping their loved ones with diabetes. In addition, if they learn about the impact self-management has on improving health outcomes, they can experience similar health benefits. Many individuals have told me their entire family is healthier and they have experienced positive health benefits similar to what happened in this study.
The author states, “Our data indicate that involving the partner in an intervention may have beneficial emotional and relational effects on the partner, at least when the intervention is focused on promoting collaboration, communal coping and emotional openness.”
We cannot forget that family members, partners and close friends may also need education and support to better understand this disease and how they can best support their loved one with diabetes. Learning and working toward effective self-management interventions together most certainly will have a positive impact both emotionally and clinically. Going it alone is difficult. Family/partner involvement as indicated in this study is the critical link in engaging individuals with chronic disease. Building on the strength of the family foundation is an intervention that all health care providers need to consider. We need to foster family involvement, because positive support tactics need to be taught, emphasized and carried out consistently.
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