Improving Diabetes Outcomes: The Diabetes Support Project

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Project Summary Studies have shown that intensive blood sugar control can reduce or forestall serious diabetes-related complications. However, innovative interventions need to be developed that can help patients achieve good, and lasting, control. We know that strong family and marital bonds help patients manage diabetes. The purpose of this study is to test whether an intervention that targets the couple and their relationship leads to better, and more lasting, improvements in blood sugar control than one that focuses only on the individual. This study is highly innovative as it is the first to address the couple as the target of the intervention. This study is also significant because we propose to deliver the intervention by telephone to increase reach to more diverse and larger numbers of patients. The specific aims are to measure the relative benefits of a couples intervention compared to an individual intervention and usual care. In one group, subjects will participate in two contacts (with a certified diabetes educator) of diabetes self- management education (DSME) followed by usual care. In one active treatment group, individual subjects will also receive DSME, followed by 10 contacts to individualize goal- setting and address emotions and diabetes. In the other active treatment group, patients and their partners will participate together and also receive DSME, followed by 10 contacts to individualize goal-setting and address relationships and diabetes. The Couples group will work collaboratively via homework and interactive discussions. We believe that better partner collaboration will have a positive impact on medical, adherence, and emotional outcomes, and that the gains achieved will be more lasting, and thus have a greater impact on diabetes outcomes. Partners do have an effect on patients, sometimes good, sometimes bad. It is time to try to enhance the positive benefits of that effect. A demonstration that a couples intervention results in significant and lasting behavior change and medical gains will lead to a tailoring of other interventions to include partners and to promote couples collaboration, as well as future work to identify for whom this intervention is most helpful.