The burden of diabetes
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According to the Centers for Disease Control and Prevention, over 29 million adults in the United States are living with diabetes.1 In 2012 alone, 1.7 million adults were newly diagnosed with diabetes.1 People with diabetes are at risk for numerous complications, including diabetic retinopathy, nephropathy, neuropathy, cardiovascular disease, amputations, and premature death.1 The management of diabetes can be relatively complex for patients. They must attend multiple physician visits per year; adhere to several different types of medications to control their disease; participate in many facets of self-care, including home glucose monitoring, healthy eating, and exercise; and negotiate barriers to management, such as cost of care and balancing work and life commitments.2
Importance of family in diabetes self-care
Diabetes self-management education (DSME) is a critical component of care for all individuals with diabetes.2 For adults with type 2 diabetes, engaging in diabetes self-care activities is associated with improved glycemic control and can prevent diabetes-related complications.2–5 Much of a patient’s diabetes management takes place within their family and social environment.6 Addressing the family environment for adults with diabetes is important since this is the context in which the majority of disease management occurs. The Institute for Patient- and Family-Centered Care defines family members as two or more persons who are related in any way—biologically, legally, or emotionally.7 Thus, family members can include nuclear, extended, and kinship network members.8
Family members can actively support and care for patients with diabetes.9 Most individuals live within a household that has a great influence on diabetes-management behaviors.10 A study of more than 5000 adults with diabetes highlighted the importance of family, friends and colleagues in improving well-being and self-management.11 Family members are often asked to share in the responsibility of disease management. They can provide many forms of support, such as instrumental support in driving patients to appointments or helping inject insulin, and social and emotional support in helping patients cope with their disease.12–13 Through their communications and attitudes, family members often have a significant impact on a patient’s psychological well-being, decision to follow recommendations for medical treatment, and ability to initiate and maintain changes in diet and exercise.14 Among middle-aged and older adults with type 2 diabetes, social support has been found to be associated with improved self-reported health in long-term follow-up.15 Family cohesion and family functioning have also been found to be positively related to patients’ self-care behaviors and to improvements in blood glucose control.16–19
Providing diabetes education to just the individual with type 2 diabetes could limit its impact on patients, since family may play such a large role in disease management. Family-based approaches to chronic disease management emphasize the context in which the disease occurs, including the family’s physical environment, as well as the educational, relational, and personal needs of patients and family members.12,20 Including family members in educational interventions may provide support to patients with diabetes, help to develop healthy family behaviors, and promote diabetes self-management.21