Family interventions in improving diabetes outcome

Diabetes mellitus is a growing worldwide epidemic concern with an estimated number of 330 million people to be suffering from it by 2030. This is a disclosure viewed very importantly against the backdrop of observance of the World Diabetes Day (WDD) November 14. In view of this the world's largest diabetes awareness campaign targets reaching out to a global audience of over 1.0 billion people in more than 160 countries. This two-year campaign is aimed at raising awareness about the impact that diabetes has on the families and the support network of those affected and promoting the role of the families in the management, care, prevention and education of diabetes.

Over 425 million people are currently living with diabetes. Families have a key role to play in addressing the modifiable risk factors for Type 2 diabetes. One in every two people currently living with diabetes is undiagnosed. Diabetes can drive families into poverty. The cost of insulin injection and daily monitoring alone can consume half a family's average disposable income. Less than one in four family members has access to diabetes education programmes. Family support in diabetes care has been shown to have a substantial effect on improving health outcomes for people with diabetes.

Diabetes is a family disease. Most clinicians would agree that children's hemoglobin (A1C) results are largely related to how they and their parents manage diabetes in daily life. It is particularly important and challenging to instill in adolescents a sense of confidence, competence and independence about managing their disease, without losing sight of the fact that they are not yet adults. The Family Approach to Diabetes Management (FADM) is a novel model that stresses patient and family self-management by identifying and exploring patterns of family communications that hinder or support positive clinical outcomes.

The "patient" is defined as the entire family, a crucial point on which all others in this model rest. Responsible self-care in an age-appropriate manner, particularly for teenagers, is a non-negotiable issue, as is going to school and doing homework. This is crucial to empowering the family to get involved in an appropriate manner. Although it is clear that parental involvement like blood glucose monitoring, insulin administration, careful monitoring of diet and exercise in diabetes management benefits the health of the child with diabetes. This may come at a psychological cost to parents. When parent involvement in diabetes care is viewed as collaborative, children benefit; when parent involvement is viewed as controlling, children-especially older ones-do not.

Better health can be provided, if the family is considered central to the management of diabetes. Family members keep the diabetic patient updated about the advancement in the world of diabetes, be it newer drugs or modern device making glucose monitoring easier. Families may require redistributing responsibilities, modifying daily routines and renegotiating family roles due to diabetes. Diabetes-related support from spouses also helps in good regimen adherence. Asian families have a reputation of being tolerant and responsible for the members no matter how tough the hardship is.

Realistic goal setting is a key element of the behavioural change process. Family members come forward with empathy to overcome the condition alleviating the burden as much as possible. For instance, a patient with diabetes foot ulcer always finds a person in the family for regular dressing and a helping hand to perform daily activities totally free of cost in Bangladesh. If family members are informed about diabetes but do not help the patient in performing diabetes self-care, it is known as the sabotage behaviour. So, family members involved in diabetes management, if not motivated enough, can affect the diabetes self-care. We now know that the families having diabetic patients should show sensibility by controlling inner conflicts and getting more coherent, motivate the persons to stay motivated and seek treatment as per rule, help nullify the negative impact of disease-related depression, provide homemade food and limit the impact of disability  for better outcomes.

Family members can feel distressed by their loved ones' diabetes due to limited knowledge about diabetes or not knowing how to support their loved ones. Family may also have misconceptions, such as believing the patient knows more about diabetes than the patient actually reports or not understanding their loved one's needs in diabetes management. Knowledge about the disease, strategies to alter family routines and optimal ways to cope with the emotional aspects of the disease are some of the aspects of diabetes self-management that family members need. 

Family and couple relationships during the adult years are as important for diabetes management and physicians, nurses, dieticians, mental health professionals, and providers from other disciplines are important sources of information, expertise and support in diabetes management. Clinical results using this approach of FADM have been amazing. A1C results improve, parent couples report improved satisfaction and interaction with their mates, and the young person becomes much less depressed and angry. 

Governments and public health planners remain largely unaware of the current prevalence of diabetes and pre-diabetes. Consequently, knowledge about this and other related risk factors can help raise awareness about the disease and lead to new policies, strategies and behaviour change communication on diabetes for prevention and management.

The writer is Consulting Nutritionist

(Weight management centre).

[email protected]