Assessing helpful and harmful family and friend involvement in adults' type 2 diabetes self-management.
Lindsay S Mayberry, Cynthia A Berg, Robert A Greevy and 1 others
PMID 30922622WHAT IT FOUND
Adults with type 2 diabetes often report both helpful and harmful family or friend involvement.
Harmful involvement went with higher HbA1c and worsening HbA1c over three months; helpful involvement did not reliably improve HbA1c.
Key findings
01Nearly all participants in both samples reported at least one helpful or harmful family or friend behavior in the past month.
02Harmful family or friend involvement was independently associated with higher HbA1c, but helpful involvement was not.
03Over three months, harmful involvement predicted worsening HbA1c, and helpful involvement predicted increased blood glucose testing; neither predicted changes in diabetes self-efficacy, diet, physical activity, or medication adherence.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study shows associations, not proof that family behavior causes better or worse diabetes control. Worse blood sugar may also lead to more harmful involvement. Participants reported family and friend behavior from memory about the past month, and test-retest reliability was checked at three months, which may not match the recall period. Helpful involvement was not associated with better HbA1c, and only blood glucose testing changed over three months, so the findings do not show that adding family support improves diabetes control. The harmful involvement score had lower internal consistency than the helpful score, especially in Study 2, where Cronbach's alpha was 0.63. Participants came from Vanderbilt and Nashville clinics, and people with recent cancer treatment, pregnancy, heart failure, end-stage kidney disease, hospice, dementia, or schizophrenia were excluded. Income was missing for 9.3% of cases and was imputed, and the paper evaluated a measure rather than testing whether using the FIAD changes patient outcomes.
Declared interests
The authors declared no competing interests. The article is listed as supported by NIH extramural research.
The easy way to misread this
Do not conclude that involving family or friends will improve diabetes control. Helpful involvement was not linked to better HbA1c, and the study tested a questionnaire, not a family-support intervention.