Analysis of diabetes education and management with family member involvement

Abstract

Objective To explore the clinical regulation of diabetes education with family members involvement by comparing the influences of different types of family member/patient combination on the long-term therapeutic compliance of patients with type 2 diabetes mellitus. Methods Total of 300 voluntary pairs of patient-family member treated from March to May in 2010 were sampled and divided into 4 groups according to the relationships between patient and family member: wife supervising husband, husband supervising wife, younger supervising elder and elder supervising younger. The influencing factors on good therapeutic compliance were evaluated in different types of subjects combination after 24-month observation by means of the modified Deborah's diabetes knowledge, self-management skills and self-evaluation table established in previous study. The independent sample t test was implicated in data comparison between two groups and variance analysis in data comparison among groups. Results There were more female than male family members(60% vs 40%, χ2=24.00, P<0.05), and mainly from the group of wife supervising husband (31%). There were significant differences in age of patients and family members, number of active contacting by family members, voluntary participation in diabetic education of family members among the groups(χ2=61.18, 107.77, 35.45, 44.79, all P<0.05). The active contacting came mainly from wives in group of wife supervising husband. Few family members voluntarily attended diabetes education program than expected with less than 3 times during 2 years of observation. Compared with that before observation(33.9%), sustained rising trend of good therapeutic compliance in group of husband supervising wife was observed in following points of observation period (60.3%, 67.9%, 70.9%, 74.1% at the 6th, 12th, 18th, 24th months respectively, χ2=6.762, 9.626, 12.131, 11.707, all P<0.05). Rising but keeping at relatively high level of the good compliance was observed in both groups of younger supervising elder and wife supervising husband but a '∧' -like distribution in group of elder supervising younger. At the end of observation, the total patients' good compliance rate was 52.3%, it was 74.1% in group of husband supervising wife, 60.8% in group of younger supervising elder, 48.3% in group of wife supervising husband and 29.0% in group of elder supervising younger. Logistic analysis showed that gender, age, frequency of active connection and grouping of family members(OR=3.593, 0.251, 2.734, 0.692, all P<0.05) as well as gender, degree of education and grouping of patients(OR=0.497, 2.558, 0.443, all P<0.05) were significant independent influencing factors on the total good therapeutic compliance. Conclusions The best long term good therapeutic compliance is found in group of husband supervising wife. As supervisor, female is better than male and the younger generation is better than the elder. Key words: Diabetes mellitus, type 2; Diabetes education; Patient compliance; Family members