Involving Patient's Partner May Improve Diabetes Control

Miriam E Tucker

August 04, 2016

For adults with poorly controlled type 2 diabetes, a behavioral telephone intervention that includes their spouse or other committed partner may make a difference, new research shows.

Results from the randomized trial were published online July 25 in Diabetes Care by Paula M Trief, PhD, professor of psychiatry and behavioral sciences at State University of New York Upstate Medical University, Syracuse, and colleagues.

"It is likely to be beneficial in several ways to involve partners who are willing.…Both partners need to agree, and the intervention should be aimed at helping them see how diabetes affects each of them and their relationship," Dr Trief told Medscape Medical News.

The idea, she said, is "to strive toward opening up communication about how they can help each other, not for the partner to be a watchdog but to be a supportive coach."

Clinicians or other healthcare workers can ask if the patient would like the partner to participate and how they are working together to address diabetes and its effect on them.

Benefit Seen Among Those With HbA1c 8.3%–9.2%

The study was a multicenter, 12-month, randomized controlled trial involving 280 couples with one partner who had poorly controlled type 2 diabetes (HbA1c > 7.5%). They were randomized to one of three interventions, all delivered by telephone by diabetes educators: behavior-intervention couples calls, behavior-intervention individual calls, or individual diabetes education calls.

All three groups received two initial 75-minute calls of comprehensive diabetes education. In the education group, there was no further intervention.

The other two groups received 10 additional calls each, lasting just under an hour.

The behavioral interventions in both of those groups included goal-setting, self-monitoring, and behavioral contracting and promoted changes in diet, activity, medication adherence, and blood glucose monitoring.

In the couples' intervention, partners were actively involved in the calls and were encouraged to provide mutual support for change, using collaborative problem-solving techniques and recognizing the reciprocal effects each had on the other. Two sessions also focused on communication and conflict management.

Two-thirds of the patient participants were male, and nearly one-third were self-described minorities. They had a mean age of 57 years and diabetes duration of 12 years and had been in the committed relationship for 25.5 years, on average. The mean baseline HbA1c was 9.1%.

Significant reductions in mean HbA1c occurred in all three groups, with no significant differences overall at any follow-up.

However, for those in the middle tertile of baseline HbA1c — 8.3% to 9.2% — HbA1c was significantly lower at 1 year only in the couples group, dropping from a mean of 8.7% to 8.0% (P < .05).

There were no changes in any of the three intervention groups for those with baseline HbA1c below 8.3%, while for those starting with HbA1c above 9.2%, all three interventions produced an improvement.

Other Improvements Seen With the Different Interventions

Compared with baseline, there were small, significant reductions in body mass index only for the couples' intervention (P = 0.021 at 12 months), while both the couples and the diabetes-education interventions significantly reduced waist circumferences compared with baseline.

However, both systolic and diastolic blood pressure actually improved most in the individual intervention group (compared with the education group at 8 months, P = 0.021 for systolic and P = 0.032 for diastolic).

But the couples intervention produced superior results for some psychosocial measures, including significantly lower diabetes distress at 12 months than in the education group (P = .009) and compared with baseline (P = .03). Also, the couples group had reduced depression scores at 8 months compared with baseline (P = .014).

On a questionnaire that asked about "satisfaction with the amount of help received," 83.5% of the couples group, 70.3% of the individual intervention, and 41.3% of the education group reported being "very satisfied."

The differences were significantly higher for the couples group compared with the individual-intervention group (P = .05) and for both of those compared with the education group (P < .001).

The fact that the patients with the highest HbA1c levels responded to diabetes education affected the results, Dr Trief said.

And she noted that the comparison of the couples intervention with a comparable individual intervention "was certainly a challenge, since there's just so much effect any behavioral intervention will have, making it harder to find differences between two behavioral interventions."

Most other studies have used "usual care" as a comparison, she observed.

"That said, I think the effect on the middle-tertile group was quite striking, especially since that's the group most clinicians see in their practices.…While it can take time to have these discussions, if it positively engages the partner it can be worth it."

This study was supported by a National Institutes of Health (NIH) grant, and the first year was funded by a NIH diversity fellowship supplement. Dr Trief has no relevant financial relationships; disclosures for the coauthors are listed in the article.

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Diabetes Care. Published online July 25, 2016. Abstract

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