Question

Explain the social dimension of diabetes ?

Answer 1

Social dimensions of diabetes winning gold‐standard model of integrated care, which was developed and evaluated as a sustainable service for improving glycaemic control and reducing diabetes complications in South London's multi‐ethnic, socio‐economically disadvantaged and growing diabetes population. This service is fully integrated into the diabetes services across Lambeth and Southwark boroughs. It consists of a liaison psychiatrist who provides clinical leadership and psychiatric interventions, psychologists and two third‐sector social support workers who provide social care in the community, working directly with the diabetes teams across the sectors.

Social dimensions of Diabetes has completed two consecutive pilot phases during which the components of the service have been refined and effectiveness demonstrated. We found high levels of mental illness and unmet need, and effected improvements in glycaemic control, psychological status and health service use. We have produced outcomes which compare favourably with new antidiabetic medications to the market and to the outcomes of the local intermediate teams. We believe this provides the best possible model of care for patients with persistent poor diabetes control despite implementing standard pathways.Diabetes self management is crucial to maintaining quality of life and preventing long-term complications, and occurs daily in the context of close interpersonal relationships. This article examines how social relationships are central to meeting the complex demands of managing type 1 and type 2 diabetes across the life span. The social context of diabetes management includes multiple resources, including family (parents, spouses), peers, romantic partners, and health care providers. We discuss how these social resources change across the life span, focusing on childhood and adolescence, emerging adulthood, and adulthood and aging. We review how diabetes both affects and is affected by key social relationships at each developmental period. Despite high variability in how the social context is conceptualized and measured across studies, findings converge on the characteristics of social relationships that facilitate or undermine diabetes management across the life span. These characteristics are consistent with both Interpersonal Theory and Self Determination Theory, two organizing frameworks that we utilize to explore social behaviors that are related to diabetes management. Involvement and support from one’s social partners, particularly family members, is consistently associated with good diabetes outcomes when characterized by warmth, collaboration and acceptance. Under involvement and interactions characterized by conflict and criticism are consistently associated with poor diabetes outcomes. Intrusive involvement that contains elements of social control may undermine diabetes management, particularly when it impinges on self efficacy. Implications for future research directions and for interventions that promote the effective use of the social context to improve diabetes self management are discussed. Diabetes self management is crucial to minimizing complications and maintaining quality of life, and is most effective when it occurs in the context of close supportive relationships. However, the heavy demands of managing type 1 (T1D) and type 2 diabetes (T2D) can alter the nature of one’s social world, and undermine the coping and emotional resources of support providers. Individuals with diabetes seek and receive support from many sources including family, parents, friends, peers, romantic partners, and the health care team. These social resources and the nature of their involvement change across development, and may be particularly important during major developmental transitions. As individuals increasingly live longer with diabetes, it is imperative to understand how to utilize support resources to enhance diabetes management and quality of life in patients and families. Psychologists are uniquely positioned to inform the scientific and medical community about social relationships that facilitate or undermine diabetes management across the life span. Psychologists are guided by broad theoretical perspectives that identify dimensions of social behavior most central to promoting effective diabetes management. For example, two well established psychological theories converge on the importance of high social support and low social control as qualities of interpersonal transactions that may facilitate diabetes management. Interpersonal theory purports that social behavior varies along two orthogonal dimensions, including affiliation versus hostility and dominance versus submission. Interpersonal transactions are generally promoted by behaviors involving high affiliation (warm, friendly) but derailed by hostility and dominance. Self Determination Theory (SDT) is a broad theory of human behavior and motivation which predicts that social contexts that fulfill three basic psychological needs connectedness (feeling loved and cared for), competence (feeling effective), and autonomy (feeling behaviors are freely chosen)promote autonomously regulated behavior. Thus, both theories predict that social transactions conveying love and acceptance without undermining one’s sense of efficacy or autonomy high social support and low social control are likely to promote good diabetes management behaviors across time. Although neither interpersonal theory nor SDT has been systematically used to study the social context of diabetes management, we use their predictions as a guiding heuristic to explore the aspects of social relationships that may be central to meeting the challenge of managing diabetes across the life span. We focus on three key times of development: childhood and adolescence, emerging adulthood, and adulthood and aging. For each section, we initially discuss the most challenging aspects of diabetes management at that time of development. We then review research showing mutual influences between diabetes management and social relationships, highlighting how the illness may alter the social context and how the involvement of others may facilitate or undermine diabetes management. We conclude by discussing implications for research and practice. A full review is beyond the scope of this article, but we highlight the most consistent and compelling findings and refer to reviews where possible. It should be noted that research has focused mostly on T1D during childhood to emerging adulthood, and on T2D during adulthood, consistent with the age at which diabetes is commonly diagnosed. Although T1D and T2D require different treatment regimens, both have complex behavioral demands that can be challenging to patients and support providers.

The Social Context of T1D in Childhood and Adolescence
T1D is most often diagnosed before children have the necessary skills to complete the complex tasks of managing diabetes independently, making it critical that parents and other adults are involved in its management. Initial diagnosis requires parents to adapt emotionally to the knowledge that their child has a serious illness that may reduce quality and length of life. Parents must rapidly master and teach others about their child’s T1D care, and constantly work to help the child achieve tight blood glucose control and avoid hypoglycemia while facilitating normal development. Parents may experience psychosocial difficulties as they adapt to these disruptions in their roles, family routines, and future expectations. Adolescence brings new challenges to T1D management, as evidenced by longitudinal deterioration in adherence and across ages 10 to 18. Understanding such deterioration is important because patterns of T1D management that are established during adolescence extend into adulthood. These patterns of management are due to a host of biopsychosocial processes, but at least partially reflect shifts in the social context of T1D management, as parental responsibility for management declines and peer influences increase. Peers are commonly cited as a source of emotional support and companionship by adolescents with T1D, but may undermine diabetes care if adolescents alter or neglect their illness to reduce stigma or increase peer acceptance. Finally, the relationships that families have with health care providers shift from a triadic relationship between the parent, child and physician, toward a dyadic patient physician relationship.

Effects of Diabetes on Social Relationships
Relationships with parents change across emerging adulthood. Responsibility for daily diabetes management (e.g., blood glucose testing, diet, insulin administration) has now shifted from parent to emerging adult, but the shift in responsibility for nondaily tasks (e.g., filling prescriptions, making appointments) lags behind (Hanna et al., 2011). Yet, parents remain an important source of support. In-depth interviews with emerging adults with T1D revealed that parents were more likely to provide diabetes-related assistance than peers or even romantic partners, due to their history of responsibility sharing and a lack of competence among peers and romantic partners (Sparud-Lundin, Ohrn, Danielson, & Forsander, 2008).

There is limited research on the implications of T1D for peer and romantic relationships during emerging adulthood, even though peers are central and serious romantic partnerships develop during this period. One study found emerging adults with T1D reported fewer friends than an acute illness control group (Jacobson et al., 1997), while a second reported no differences in the number of friends between those with and without T1D (Pacaud et al., 2007). Helgeson et al. (2015)showed that emerging adults with T1D reported less friend support than those without T1D across three years (ages 18-20), but no differences in friend conflict. With respect to romantic relationships, Jacobson et al. (1997) found that emerging adults with T1D were equally likely to have a romantic partner as the comparison group, but reported less trust and friendship in the romantic relationship. Helgeson et al. (2015) found that romantic relationships of emerging adults with versus without T1D were viewed as equally supportive for males, but as less supportive for females. Thus, T1D has the potential to alter friendships and romantic relationships, but more research is necessary.

Effects of Social Relationships on Diabetes Management :-Family support remains an important predictor of diabetes outcomes among emerging adults. In a longitudinal study, parental support during adolescence predicted fewer depressive symptoms and less alcohol usage during emerging adulthood for those with T1D. Gillibrand and Stevenson (2006) showed that family support was the strongest psychosocial predictor of self care behavior among 16 to 26 year olds with T1D. Parent support in late adolescence also predicted positive changes in psychological well being, decreases in smoking, and better self care over a one year period during the transition to emerging adulthood. By contrast, parent controlling behaviors predicted increased risk behavior and poor health outcomes among emerging adults, but this association was weaker for those with versus without T1D. Parental control may thus have more complicated relations to outcomes in the context of emerging adults with T1D. Although researchers and health care professionals understand that friends and romantic partners play a role in T1D management during emerging adulthood, few studies have examined the implications of such relationships for diabetes health among emerging adults. A longitudinal study of friend support and conflict across the transition to emerging adulthood found that friend conflict was a stronger predictor of health behavior changes over the next year (i.e., increases in alcohol usage and binge drinking) than was examined support and conflict from both friends and romantic partners in emerging adults. Romantic relationships were a stronger predictor of diabetes management and psychological well being than friend relationships in emerging adults, but the implications of romantic relationships differed as a function of illness status. Emerging adults with T1D were less likely to benefit psychologically from supportive aspects of romantic relationships and more likely to suffer from conflictual aspects of romantic relationships than those without T1D.