Supporting patients and their families on World Diabetes Day

November 14 is World Diabetes Day, and this year’s theme is ‘The family and diabetes’.
 
The idea behind the theme is to recognise the key value family members and loved ones provide to people living with diabetes.
 
Like a stone dropped into a pond, the ‘ripple effect’ of diabetes reaches far and, as GPs, it is important to understand that we need to engage and assist the people providing our patients with diabetes with emotional, social and financial and practical support.
 
Here are some issues families may experience with different types of diabetes – and the ways in which GPs can assist them.
 
Type 1 diabetes
Parents with a child who has been newly diagnosed with type 1 diabetes are likely to be undergoing considerable stress from trying to understanding the illness, concern about hypoglycaemia, the need to provide the necessary education for the child on their condition and manage the monitoring and administration of insulin through pumps or injections.
 
In addition, they have to ensure that any other siblings receive the support they need. The impact may be substantial.
 
There is often also a financial impact, as families need access to diabetes-related products such as pumps and newer technology that helps the management of type 1 diabetes. The National Diabetes Services Scheme can often assist with some of this.
 
Family of adolescents with type 1 diabetes have to support them with the emotional and physical needs that a life-long chronic illness may bring.
 
Gestational diabetes
Women who develop gestational diabetes have to consider and care for themselves as well as new additions to their family, and consider the impacts of ensuring the health of both.
 
Type 2 diabetes
Adults with diabetes need family support to assist with self-management, such as the practical encouragement of a partner for a healthy diet or maintaining physical activity.
 
A review of five studies in type 2 diabetes showed that family support had a positive impact on healthy diet, increased perceived support, higher self-efficacy, improved psychological wellbeing and better glucose control.
 
The innate challenges of modifying a diet with diabetes is best supported with family members involved. Evidence shows that social support can improve wellbeing in middle-aged and older adults.
 
How can a GP assist people with diabetes and their families?
One way GPs can help is to ‘engage all for one’ – that is, engage family members to support changes for modifiable risks such as maintaining healthy lifestyle choices.
 
Health risk behaviours may cluster in families so if, for instance, the main cook for the family is not the person with diabetes, a broader approach to dietary change may require this person to be involved.
 
Any young person with diabetes needs the support and engagement of their carers or parents. What is often forgotten is the adolescent with type 1 diabetes who is transitioning to independence and adulthood.
 
Living with a chronic disease is associated with higher rates of distress and mental health problems, which also needs to be taken into account. GPs in these cases should consider appropriate referral, not just for the adolescent, but also for parents and carers who develop distress.
 
Refer to Appendix C and Appendix D in the RACGP’s General Practice Management of type 2 diabetes for tools to guide assessment.
 
It is also important to keep in mind that diabetes risks are increased in family members, so assess all family members at evidence-based intervals for the possibility of developing the disease.
 
If both parents have type 2 diabetes, the lifetime diabetes risk for children is 50% higher than others. Siblings of a child with type 1 diabetes have a one in 10 risk of developing type 1 diabetes before the age of 50. Children of women with gestational diabetes have an eight-fold increased risk of impaired glucose tolerance or type 2 diabetes by the ages of 19–27. If there are numbers of close family relatives whom develop diabetes, GPs should always contemplate the possibility of monogenic diabetes.
 
Dr Gary Deed is Chair of the RACGP Specific Interests Diabetes network.

Gestational diabetes Type 1 diabetes Type 2 diabetes World Diabetes Day