(PS6-A9) Associations Between Family Involvement and Diabetes Distress for Adults with T2D and Their Support Persons

Background: Around 37% of persons with diabetes experience clinically significant levels of diabetes distress. Additionally, many family members experience their own distress related to the patient’s diabetes. Understanding associates of diabetes distress is the first step toward alleviating distress. Despite the importance of family and friend involvement in diabetes self-management, little research has examined its role in relation to diabetes distress.

Methods: Adults with Type 2 Diabetes (T2D) were identified through the medical record of a large academic medical center in the Southeastern US and invited to participate in an RCT of a family-focused self-care support intervention. Eligible patients were asked to invite an adult support person, with whom they were comfortable discussing diabetes management and health goals, to co-enroll in the study. Patients and support persons each completed a baseline assessment reporting on their experience and provision of family involvement in diabetes management (Family and Friends Involvement in Adult Diabetes – Helpful & Harmful scales), respectively, and their own diabetes distress (Problem Areas in Diabetes Scale). We used linear regression with robust standard errors to assess cross-sectional associations between family involvement and diabetes distress for patients and support persons, separately. Then, we assessed associations between support person reports of their own involvement and patient-reported diabetes distress. Models for patient distress were adjusted for patient age, gender, race/ethnicity, income, education, diabetes duration, and insulin use. Models for support person distress were adjusted for support person age, gender, and race/ethnicity.

Results: Patients (N = 355) were 56.8 (SD = 11.0) years old on average; 51.3% male; 38.0% were Black, Hispanic, or multi-racial; and 34.9% reported an annual income < $50K. Average diabetes duration was 15.3 (SD = 2.9) years and 37.3% were taking insulin. Support persons (N = 297) were 52.0 (SD = 14.1) years old on average; 28.0% male; and 31.7% were Black, Hispanic, or multi-racial.  

Patients’ reports of experienced harmful family involvement over and above helpful involvement were associated with own diabetes distress (b = 1.92, p < .01). Likewise, support persons’ reports of their own harmful involvement over and above helpful involvement were associated with more diabetes distress (b = 3.33, p < .01). Finally, support persons’ reports of their own harmful involvement over and above their own helpful involvement was also associated with higher diabetes distress for the linked patient (b = 2.59, p < .01).

Discussion: Helpful and harmful family involvement have previously been linked to better diabetes self-management and A1c. This is the first study, to our knowledge, to examine associations between family involvement and diabetes distress including associations across the dyad. Support people may engage in more harmful involvement (i.e., nagging) when they are distressed about the patients’ diabetes. Experiencing these behaviors from family/friends is associated with more distress for patients. This suggests distressed patients may benefit from interventions targeting the dyad.