Religion Shapes Glucose Control in Marriages With Diabetes

Pam Harrison

June 19, 2017

Religious beliefs can affect how diabetic patients and their spouses cope with the stress of diabetes, with positive attitudes resulting in good lifestyle habits that result in greater success with glycemic control for the diabetic spouse, new US research indicates.

The study was published online June 7 in the Journal of Marital and Family Therapy.

"The current study found that both partners' use of religion to cope with type 2 diabetes–related stress significantly predicted their involvement in shared glycemic control behaviors," write Frank Fincham, PhD, Florida State University, Tallahassee, and colleagues.

But prior work has shown that only 10% of doctors report addressing the subject of religion with their patients, the researchers say.

Physicians need to overcome their reluctance to discuss such issues, they add, because they could explain to couples who are religious how their faith could help them to handle the stress that diabetes places on a marriage and in turn help them improve lifestyle behaviors and subsequent blood glucose control in the affected spouse.

Positive Coping = Better Control; Negative Coping Is the Opposite

The study involved 87 heterosexual couples in which one spouse had type 2 diabetes and the other did not; both were given questionnaires to complete. Spouses had been married an average of 24 years, and over 89% of both individuals within each couple reported some degree of religiosity.

Type of religion wasn't specified, and a broad mix of ethnic groups was examined — around half of the participants were white, 20% Latino, 15% African American, just under 10% Asian, and around 5% Middle Eastern. They were all recruited in Southern California: from a diabetes treatment center, a diabetes community support group, a primary care clinic, or local faith-based organizations.

"Religious coping was measured using a brief version of the RCOPE, a comprehensive measure of religious coping," the investigators note.

Positive religious coping involves strategies such as people viewing God as a partner in their effort to control the stress of diabetes, while negative religious coping reflects a feeling that the diabetes means they have been abandoned by God, they explain.

Glycemic control was assessed by rating the diabetic spouse's response to how well they kept their blood glucose in range, varying from never to always.

 "Compared with their nondiabetic partners, the diabetic spouse engaged in significantly more positive religious coping"  (P < .01) yet still displayed more depressive symptoms (P < .05), the researchers report.

Overall, both the diabetic and the nondiabetic spouse engaged in significantly more positive than negative religious coping strategies in their management of diabetes-related stress (P < .001).

As Gregory Seibert, doctoral candidate in marriage and family therapy at Florida State University and coauthor of the report, explained, the study indicates  differences in the way diabetic spouses and nondiabetic spouses cope.

The more likely the diabetic patient was to engage in negative religious coping, the less likely they were to share good glycemic control behaviors with their partner.

"In other words, religious coping that reflects tensions and spiritual struggle involving doubt about God's love and care, for example, was related to fewer shared activities with the spouse that focused on glycemic control," he added.

Physicians Should Assess Religious Beliefs at First Presentation

He also acknowledged that it may be difficult for physicians to bring up the topic of spirituality or religion, but it is important to provide patients with an opportunity to discuss this, if relevant, he said. 

One way Seibert recommends physicians approach this is to provide patients with a short assessment on first presentation.

Spiritual assessment tools, such as FICA and HOPE allow patients to acknowledge their spirituality or religion and serve as a catalyst to initiate a discussion about religion in a medical setting.

"These assessments can be extremely useful to physicians as patients report on how their beliefs impact their current condition as well as how their spirituality or religion can be used to improve their medical care," he concluded.

The authors have disclosed no relevant financial relationships.

J Marital Fam Ther. Published online June 7, 2017. Abstract

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