Aim: Prior research has yielded inconsistent findings on the effects of spousal support in type 2 diabetes (T2D) management, yet most studies were cross-sectional and relied exclusively on patient perceived support. This study aimed to examine the within-person effects of daily perceived and enacted spousal support in T2D self-care on glycemic control.

Method: Adults with T2D (N = 63; age M = 61; 67% male; 70% Caucasian) and their spouses participated in a parent study. Patients wore continuous glucose monitors (CGM) for 7 days and concurrently, each evening, both partners responded to the following item: Did you/your partner say or do anything TODAY to try to influence your/spouse/partner’s behavior with regard to managing your/his/her diabetes? The patient item version represents perceived and spouse version enacted support, respectively. CGM data were used to calculate 4 indices of daily glycemic control: mean (M), standard deviation (SD), coefficient of variation (CV), and time in range (TR).

Results: A multilevel dynamic structural equation model was estimated for each outcome. Within-person effects of perceived and enacted support were allowed to vary between persons and time was a covariate. Enacted support significantly predicted better glycemic control across all outcomes (βM = -.32, βSD = -.30, βCV = -.19, βTR = .42, ps < .05). Conversely, perceived support was unrelated to most outcomes (βM = .06, βSD = .17, βCV = .12, ps > .05), but significantly related to lower TR (βTR = -.40, p = .004).

Conclusion: Results echo research on invisible (enacted, not perceived) versus visible (enacted, perceived) support: the former is consistently linked to positive outcomes, whereas visible support is often ineffective or detrimental. Indeed, perceiving support receipt may undermine patient self-efficacy for T2D management and in turn, reduce self-care adherence (e.g., medication, diet). Replication and more research are needed to determine the extent to which the support visibility model applies to the context of T2D.

Disclosure

E. Soriano: None. J. Laurenceau: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R21DK098679, F31DK120201)

© 2020 by the American Diabetes Association
2020
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