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Diabetes Management for Couples

From the point of view of a person with diabetes, daily self-management involves making choices – lots of them; when, what, and how to eat, for instance; when and how to engage in physical exercise; what items to carry around all the times. These and many others are repeated ad infinitum – all day, every day. The person must also make less frequent but extremely significant decisions about his or her choice of therapies and overall approach to treatment. These comprise diabetes self-management – a very complex task that is of critical importance for achieving metabolic targets and other outcomes.

It is a fact that these changes may seem a little overwhelming. But it doesn’t mean that life does need to go on hold. Family and marital support have been shown to be associated with better treatment adherence, illness adaptation, and blood sugar control in studies of individuals with diabetes.

Research has shown that diabetes affects both the patient and family, and that support from family and partners helps diabetes patients manage their illness better. However, diabetes programs rarely involve the partner even if there are several documentations regarding the consistent link between social relationships and health.

A study further explored the marital or cohabiting relationship, which was shown to be especially relevant to clinicians and educators because the self-care regimen often involves spouses or significant others.

In this study, the participants discussed a variety of healthcare needs and preferences for type 2 diabetes management. Although being in charge of one’s own diabetes was the predominant mode, these couples worked toward a guiding principle of teamwork to maintain diabetes care.

Four core themes emerged from the discussions: Educate yourselves, Talk about the disease, Work Together, and Be your own advocate.

Educate Yourselves
The constant influx of new and occasionally contradictory diet, exercise, and medication recommendations made self-care management challenging to the couple living with diabetes. A man with diabetes shared what he believed to be the most significant barrier in diabetes management: “As a society, we have not done a very good job of teaching people what is a healthy diet. The lesson has not been learned by many people. We need education for the entire family.”

Education about type 2 diabetes is not something patients with diabetes and spouses do once at the time of diagnosis. Maintaining knowledge, skills and tools in diabetes management helps patients or spouses stay up-to-date and avoid many of the complications associated with the disease. By learning on their own, couples are able to plan a diabetes management program that meets their needs and is based on their work schedules, family demands, leisure/recreational activities, lifestyle behaviors, and other health problems. Moreover, the diabetes healthcare team should strive to devote more attention to providing accurate and sensitive education throughout the course of a couple’s diabetes care.

Talk about the disease

The inability to openly communicate on the subject of diabetes fuelled significant negative emotions, including feelings of frustration, anger and hopelessness, in many of the patients and spouses.  The lack of communication within the community was attributed to the public not having enough accurate information about the disease.

A diabetic patient conveyed his sense of frustration with the healthcare community’s inability to talk to him about his diabetes management: “Teach me how to live with it on a daily basis because it is chronic – it is not going anywhere!”  Both patient and spouse expressed a desire for healthcare practitioners, as well as friends and family members, to be more willing to talk about all aspects of the disease and offer practical suggestions for successful management.

Couples maintained that talking about diabetes was a necessary first step in learning how to cope with the complexities of daily life.  As one spouse remarked, “I think the important thing is to have somebody that you can ask questions to.”

The insights offered by the couples in the study suggest that support-focused interventions should incorporate communication strategies adapted to diabetes specific education.  Diabetes management, as well as social relationships, depend heavily on communication; thus, improved communication could significantly enhance quality of life for couples living with diabetes while also potentially encouraging open communication about diabetes within the community. Additionally, diabetes management requires skills in problem solving to effectively identify high-risk situations for relapse and to minimize barriers to self-care.

Together, patients and spouses can decide to either avoid high-risk situations or generate potential solutions before such situations arise. Collaborative decision-making regarding effective solutions to high-risk situations can improve coping with a complex disease.

Work together
Teamwork was a prominent theme in the care of diabetes among couples. Both patients and spouses echoed the importance of support with regard to self-care behaviors, emotional well-being, and overall quality of life.
This sentiment was articulated best by the husband of a diabetic patient: “I know that my wife taking care of her diabetes is her responsibility, but I can support it wherever I can.”

To assist couples with the day-to-day management of diabetes, future interventions should maximize interactions with couples. The management of type 2 diabetes requires significant lifestyle modifications for patients and spouses. A study demonstrated that managing type 2 diabetes collectively is achievable, but sustaining one’s management may be difficult without constant support. Both patient and spouse may need to make changes in their diet, dietary patterns, and dietary schedules and begin or sustain an exercise program. Both patient and spouse would benefit from education about diabetes and the administration of medications. Each component of self-care, such as eating a healthy diet and engaging in regular physical activity, means setting a specific, achievable goal to be successful. Goal setting is a component of the problem-solving process. Once a potentially effective solution to a problem has been identified, the setting of a goal enables one to focus attention and effort to achieve meaningful change.

As the number of adults with diabetes continues to grow, having the support of others will become increasingly important. Spousal/partner support is a vital component in the management of type 2 diabetes.

Be your own advocate
The partnership of care described in the study extended beyond the healthcare system. All of the participants agreed that their diabetes management was not the sole responsibility of the healthcare provider, but rather was the shared responsibility of family members, physicians, and the greater health community. In addition, successful management depended on a couple’s willingness to take the lead in management and to voice their concerns regarding medications, complications, and the difficulties of adhering to lifestyle changes (particularly diet and exercise recommendations).

A wife of a diabetic stressed the importance of asking for help: “I am going to try saying my husband is a diabetic and I need your support here.” Patients should learn to assert their specific needs while simultaneously controlling the challenges they faced in day-to-day management. One participant captured this sentiment precisely: “Really, you have to be your own advocate.”

Similarly, the importance of a spouse taking an active role in the patient’s management decisions cannot be overemphasized. A husband explained his sense of responsibility to his wife’s diabetes management: “She has the disease, but it affects everything we do. I had to realize that this was something that affected both of us, and I have come to appreciate that.”

Indeed, there is so much going on in a patient’s diabetes care plan that it is easy to let health professionals (e.g., nurses, dietitians, pharmacists, doctors, exercise physiologists, podiatrists, and social workers) worry about the management decisions. But doing so will not result in adequate diabetes control. Patients need to realize that living with type 2 diabetes can be overwhelming for any one person; having the support of one’s spouse or partner is necessary to maximize successful management and, ultimately, improve quality of life for both partners. The four themes presented in this article represent four points of intervention for couples living with diabetes.

Together, couples can utilize these themes and talk to their healthcare providers on a regular basis. Whether couples work with one healthcare provider or a team of providers, knowing their providers will enhance their ability to communicate with them. In addition, couples can take advantage of opportunities in their community and help facilitate community-based programs for the management of diabetes. All in all, opportunities abound for meaningful interactions between patients and spouses to bolster successful management of type 2 diabetes. Such interactions enable patients to meet their individual and social needs by encouraging them to select and initiate self-care behaviors to achieve and sustain optimal glycemic control.

Couples as a “team, in sickness and in health”, can learn to work together to identify and engage in behaviors that can serve to buffer the effects of diabetes on health and overall quality of life.

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