April 2019

In This Issue: Improving Care for Veterans with Diabetes
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Enhancing Social Support for Diabetes Self-Management among Veterans

Feature Article

Diabetes affects 25% of patients in the VA healthcare system and is among the leading causes of morbidity and mortality. Self-management, including healthy eating, being physically active, and taking medications, is critical to preventing diabetes complications, but many Veterans fall short of meeting self-management recommendations.Enhancing the quality and quantity of existing social support resources is a promising strategy to improve self-management among Veterans, as self-management behaviors are influenced by a patient's social network. However, little is known about Veterans' existing social support resources for self-management, how to best leverage social support to facilitate self-management, and whether there are differences by gender.

The main objective of this ongoing (2017–2022) HSR&D study is to test a partnered virtual intervention that includes Veterans with diabetes and support persons, and which aims to reduce unsupportive behaviors and enhance supportive behaviors to facilitate Veterans’ self-management. Investigators will conduct telephone interviews with Veterans (n=36) to characterize social support resources for self-management. They also will conduct telephone interviews with support persons identified by Veterans (e.g., spouses, adult children, and friends; n=16) to understand their perceptions of helpful and harmful support. Further, investigators will pilot test modifications to an existing partnered self-management intervention and evaluate its feasibility, acceptability, and preliminary clinical improvement in self-management behaviors and hemoglobin A1c (HbA1c) overall—and by gender.

Findings: Telephone interviews were completed with 36 Veterans (18 men, 18 women) with diabetes and 16 of their support persons. Interviews with Veterans explored how they managed their diabetes, social network members involved in their self-management, and ways these individuals helped or hindered self-management. Recorded and transcribed interviews were analyzed and findings show:

• Veterans primarily managed their diabetes with medications and dietary modifications.
• Few Veterans regularly engaged in physical activity, which was often attributed to pain or comorbid conditions.
• Most Veterans had >=1 social network member involved in their self-management, including partners/spouses, adult children, and friends, many of whom had pre-diabetes/diabetes.
  • Participating in self-management tasks (e.g., food preparation), providing direction, and assisting with everyday living were the most commonly described helpful support behaviors among both men and women.
• Women discussed receiving emotional support and role modeling from their social networks, whereas men spoke of social network members interacting with the healthcare system.
• Compared to men, women noted managing diabetes on their own and experiencing insufficient support. Women also experienced unhelpful or obstructive behaviors, including nagging and sabotaging (i.e., bringing unhealthy foods into the home).

Analyses of support person interviews are underway.

Impact: Innovative, Veteran-centric interventions are needed to improve diabetes self-management. This ongoing research has the potential to fill this gap, particularly for women Veterans. If effective, this strategy also could be tailored to other chronic diseases or disease prevention.

Principal Investigator: Kristen Gray, PhD, MS, is an HSR&D Career Development Awardee and part of  HSR&D’s Center of Innovation for Veteran-Centered and Value-Driven Care in Seattle WA.

Publications: Gray K, Hoerster K, Reiber G, et al. Multiple domains of social support are associated with diabetes self-management among Veterans. Chronic Illness. January 2018; Epub ahead of print.

View project abstract.