Reluctance to Reach Out to Others Can Boost Mortality Rate 33 Percent Among People With Diabetes

People with type 1 or type 2 diabetes who find it difficult to trust others or reach out for emotional support may be shortening their own lives. That’s the conclusion of a five-year University of Washington study that showed a 33 percent higher mortality rate among diabetes patients who did not interact well with their healthcare providers or other people.

The study tracked 3,535 adults in the Puget Sound area of Washington State. Participants completed a questionnaire to determine if their relationship styles were “interactive”-able to easily relate to others and get close to them-or “independent”-dismissive or mistrustful of close relationships.

The researchers did not include people in the study who had been diagnosed with depression, reasoning that the condition could confuse the results by mistaking a cause-depression-for an effect-independence. They also controlled for body mass index, marital status, age, previous complications from diabetes, and other medical conditions.

The study, which was published in the March issue of Diabetes Care, a journal of the American Diabetes Association, found that the independents’ reluctance to engage emotionally or trustingly with other people extended to their healthcare providers. As a result, independents were more likely to miss appointments, disregard exercise and diet advice, record higher blood sugar levels, and adhere less to drug-taking schedules.

That pattern of behaviors, the researchers believe, probably causes the higher mortality rate among independents. They called for more study of independents’ behavior, however, with an eye to understanding their motivations and developing interventions that would help them adhere to the routines that come with having diabetes.

Interestingly, the researchers found that both interactive and independent patients saw their healthcare as being often disorganized, hurried, and impersonal.  Interactives were more likely to shrug off minor problems, seeing their providers as knowledgeable experts doing their best under difficult circumstances. Independents, however, worried more about being controlled or rejected, even as they feared that they might not receive any help at all.  

Dr. Paul Ciechanowski, associate professor of psychiatry and behavioral sciences at the University of Washington and an affiliate investigator at Group Health Research Institute in Seattle, reported the study’s findings. He said that the biggest concern about independents’ behavior centers on the fact that successful diabetes self-management often requires close personal interactions. For example, meal planning, exercise and medication schedules, and significant changes in habits, such as quitting smoking, are all activities that require the help,  knowledge, and encouragement of others.

Ciechanowski noted that there is no conventional therapy or approach for dealing with independents. He suggested that healthcare professionals try to directly address their behavior in nonjudgmental ways and from there set up simple goals and schedules for seeking support in managing the disease.

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Difficulty trusting and reaching out to others may shorten diabetes patients’ lives

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