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Diabetes: A Family Affair

A person with diabetes faces a lot of change. Not necessarily from the effects of the disease, which are slow, but from immediate changes in lifestyle. "Diabetes is a disease that requires behavior change," notes professor Paula Trief PhD, consultant psychologist to University Hospital's Joslin Diabetes Center. "People with diabetes have to watch their diet, exercise and take medication."

According to Trief, diabetes is a disease where a merger of medicine and psychology can benefit patients. In the 1990s researchers found that patients with supportive partners fared better in adapting to the disease. "We wanted to take those findings further," Trief says, "and see if we could create an intervention for couples that would do three things: increase adherence to medical recommendations, help patients achieve lower blood sugar levels and improve the relationship."

The counseling is done using speakerphones. "Patients and their spouses don't have to travel. The phone has greatly expanded whom we can reach," says Trief. The NIH trial grant will compare patients counseled with their partners to patients counseled alone.

SUNY Upstate is also part of a large, NIH-funded multi-site trial to see if family counseling can help young people combat diabetes. Once considered the disease of middle age, type 2 diabetes is affecting those as young as 10. The study, led by Ruth Weinstock MD, follows 750 children for five years: half are receiving lifestyle counseling and medication, and half are receiving medication alone. Results will be released in 2009.

"It's difficult to get kids to make the necessary changes in diet and exercise," reports Associate Professor Ron Saletsky PhD, a co-investigator on the study along with Trief. "They don't feel sick, and there is peer pressure to eat what their friends eat."

Children who are participating in the intervention part of the study are assigned a counselor who recommends dietary changes for the entire family. Among a smaller subset of participants Saletsky also is examining how the parent-child relationship influences compliance. "

The basic assumption is that if people can change their lifestyles, complications from diabetes can be forestalled," Saletsky adds.