Mistrust can exact a high toll. Being overly cautious or dismissive in relating to people, researchers are learning, may shorten the lives of people with diabetes.
Diabetes patients who have a lower propensity to reach out to others have a higher mortality rate than those who feel comfortable seeking support. These are the findings of a 5-year study reported by Paul Ciechanowski, MD, associate professor of psychiatry and behavioral sciences at the University of Washington (UW) and an affiliate investigator at Group Health Research Institute in Seattle.
This is the first known study to examine the association between relationship styles and mortality.
The researchers examined 3,535 adult patients with type 1 and type 2 diabetes enrolled as Group Health Cooperative patients in the Puget Sound area of Washington state. Because depression has been linked to premature death from diabetes, patients with depression were not included to avoid confounding the study results.
The patients 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.
“These ways of relating often extend to their relationships with health-care providers,” the researchers said in a press release.
For the study, diabetes patients who were mistrustful of people, including health care providers, had a 33% 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.
“Prior studies have shown that lower support seeking is associated with poorer adherence to treatment,” Ciechanowski said.
An independent relationship style, he explained, 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 injection-based medication use, blood sugar monitoring, and smoking cessation.
“Many self-management behaviors related to diabetes are optimally carried out in collaboration with others -family, peers and health-care providers,” he said.
There are approaches, according to Ciechanowski, that health-care providers can try to improve collaboration with diabetes patients who have an independent relationship style, such as directly and non-judgmentally talking about this style. Also, providers might coach patients and help them set simple goals in seeking support in managing their diabetes. However, the effectiveness of such approaches in reducing the higher death rates among such patients has not yet been tested.