doctors hands

Diabetes patients who are less likely to reach out to others for support have a 33 percent higher mortality rate that those who feel comfortable doing so, perhaps because they tend to miss appointments, have higher glucose readings, and express a lower satisfaction with health-care. They also report poorer home treatment in areas such as foot care, exercise, diet, oral and injectible medication use, blood sugar monitoring, and smoking cessation. (Courtesy: iStockphoto)

U. WASHINGTON (US)—Diabetes patients who are less likely to reach out to others for support have a 33 percent higher mortality rate than those who feel comfortable doing so, according to a new study.

Individuals with an interactive style find it easy to get close to others and rely on them, and in turn are dependable for others. Those with an independent style tend to be either dismissive or fearful of close relationships. The report was published in Diabetes Care, a professional journal of the American Diabetes Association.

This is the first known study, the research team believes, to examine the association between relationship styles and mortality.

“These ways of relating often extend to their relationships with health-care providers,” says Paul Ciechanowski, associate professor of psychiatry and behavioral sciences at the University of Washington.

In a five-year study, Ciechanowski and colleagues examined 3,535 adult patients with type 1 and type 2 diabetes who completed a relationship questionnaire. Based on the results of this survey, patients were divided into two groups: those with an interactive style and those with an independent style in relating to people.

Regardless of their style, most patients perceive health care as rushed, impersonal and fragmented. Those with an independent style also reported feeling threatened by the power health-care providers had.

Some were highly attuned to signs of rejection; others were sensitive to being controlled, and at the same time worried that help would not be available for them. Those with an independent style in relationships often felt a wall existed between patients and providers.

Patients who were mistrustful of people, including health-care providers, had a 33 percent higher mortality rate than those who interacted easily with others and sought comfort and support.

The researchers found the significantly higher risk of death among diabetes patients who were less likely to seek support still held after controlling for other potential risk factors for mortality such as age, marital status, other medical conditions, complications of diabetes, and body mass index.

The exact mechanisms behind the link between an independent relationship style and a higher mortality rate are not yet known. Further research is needed to delineate the reasons and to develop effective interventions.

“Prior studies have shown that lower support seeking is associated with poorer adherence to treatment,” Ciechanowski notes.

An independent relationship style, he explains, is often played out in missed appointments, higher glucose readings, lower satisfaction with health-care, and poorer home treatment of diabetes in such areas as foot care, exercise, diet, oral and injectible medication use, blood sugar monitoring, and smoking cessation.

“Our research is based on a developmental theory known as attachment theory where earlier experiences often shape an individual’s ability to trust later in life,” Ciechanowski explains.

“As clinicians, we have to keep in mind that what we say and how we say it can make a big difference in trust between clinician and patient—which has implications for treatment adherence and health outcomes.

“Bedside manner matters. Also, as stewards of health care, we have to be mindful about what our fast-paced health-care system says to patients to engender trust or not. Long waits, less face-to-face time with providers, rashly delivered health information, and lack of continuous care can reduce trust—particularly in those with an independent relationship style.”

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