Diabetes is a condition that affects the body’s ability to use glucose (a form of sugar) for fuel. When we eat, the sugars and starches in foods are broken down into glucose. The pancreas releases insulin, a hormone that unlocks cell walls and allows the glucose to enter and be used as fuel. People with diabetes either don’t make insulin, or are unable to make effective use of insulin. Thus, though high levels of glucose circulate in the blood, the cells are deprived of energy.
According to the Centers for Disease Control and Prevention, about 23.6 million Americans have diabetes. Roughly 1.6 million new cases are diagnosed each year. There are two main types. Type 1 diabetes occurs when the body mistakenly attacks the insulin producing cells in the pancreas. Patients need regular injections of insulin to stay alive. Type 1 is the least common of the two main types, accounting for only 5 to 10 percent of all cases of diabetes. It’s typically diagnosed during childhood, but can occur at any age.
Type 2 diabetes initially occurs when the body is not able to effectively use insulin (called insulin resistance). Over time, the pancreas also loses its ability to produce insulin. This type is more commonly seen in older adults who are overweight, inactive and have a family history of diabetes. However, doctors are also seeing cases in younger, obese children.
Over time, high levels of glucose can damage the lining of the blood vessels and contribute to organ damage. Patients are at higher risk for heart disease, stroke, high blood pressure, blindness, kidney disease, nerve disease, amputations and dental disease. In 2007, the direct medical costs for diabetes treatment in the U.S. was $116 billion. Diabetes is the seventh leading cause of death in the U.S.
Tight control over blood glucose levels is associated with a reduced risk for developing diabetes complications. Experts say diabetics with a significant level of social support are more likely to stick to treatment recommendations and maintain better control over glucose levels.
Researchers at the University of Washington in Seattle have found there is another factor in the layer of social support that may affect diabetes outcome. It’s relationship style. Psychiatrist/Researcher Paul Ciechanowski, M.D., M.P.H., identifies two important relationship styles: interactive and independent. People with an interactive style are comfortable reaching out to others for help or, in some cases, are dependent on others for help. Those with an independent style are very self-reliant and often afraid to reach out to others for help.
Investigators have found 48 percent of diabetics have an independent relationship style. Though they may feel like they can handle self-care, the responsibility can sometimes be overwhelming, especially for those who have work and family concerns, as well. In fact, diabetics with an independent relationship style are more likely than those with an interactive style to miss doctor appointments, adhere to exercise and diet recommendations or take medication as directed.
In a recent study, Ciechanowski and his colleagues categorized type 1 and type 2 diabetics by relationship style, then followed them for five years. The researchers found participants with an independent relationship style had a 33 percent higher risk of death.
Ciechanowski says physicians shouldn’t assume a self-assured patient is able to take control of his/her care. In addition, even patients who have abundant resources for help may not necessarily reach out to them. Some patients may not know how to reach out to others. Physicians can also take a proactive approach by contacting patients periodically to determine if help is needed.
For general information on diabetes and diabetes management:
American Diabetes Association, http://www.diabetes.org
Centers for Disease Control and Prevention, http://www.cdc.gov/diabetes
National Institute of Diabetes and Digestive and Kidney Diseases, http://www.niddk.nih.gov
Ciechanowski, Paul, M.D., et al., “Relationship Styles and Mortality in Patients with Diabetes,” Diabetes Care, March 2010, Vol. 35, No. 3, pp. 539-544.
King, Diane, Ph.D., et al., “Self-Efficacy, Problem Solving, and Social-Environmental Support are Associated with Diabetes Self-Management Behaviors,” Diabetes Care, April 2010, Vol. 33, No. 4, pp. 751-753.
Rosland, Ann-Marie, M.D., et al., “When is Social Support Important?” Journal of General Internal Medicine, December 2008, Vol. 23, No. 12, pp. 1992-1999.
Sloan, Frank, Ph.D., et al., “Preferences, Beliefs and Self-Management of Diabetes,” Health Services Research, June 2009, Vol. 44, No. 3, pp. 1068-1087.