RE: an article from diabetic news

[Guest guest]

I've read before that lonely people tend to die younger, so this article

makes sense to me.

Becky

_____

From: blind-diabetics

[mailto:blind-diabetics ] On Behalf Of LaFrance-Wolf

Sent: Saturday, April 10, 2010 3:33 PM

To: blind-diabetics

Subject: RE: an article from diabetic news

Vickie,

I don't find this unusual. I found over my professional life that people

who not trust or who have difficulty with relationships in general, so not

recover from any illness as well as those who do have good relationships

with people.

an article from diabetic news

I have found a very interesting article that is alarming. I think after

reading it, you will understand what I have to say here: If anyone needs a

friend, or an extra friend, I want to be available to email or talk on the

phone, not as anything but a friend. In other words, I am not a counselor

but just a caring person. I'm sure others here would offer to do the same,

Anyway, here's the article.

--Vicki, pylecomcast (DOT) <mailto:pyle%40comcast.net> net

Self-reliant diabetes patients had a 33 percent higher mortality rate during

a 5-year study, compared to diabetes patients who interacted easily with

others and sought support.

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 five-year study reported by Dr. Ciechanowski,

associate professor of psychiatry and behavioral sciences at the University

of Washington (UW) and an affiliate investigator at Group Health Research

Institute in Seattle.

Ciechanowski also directs the training insitute at the Center for Healthcare

Improvement for Addictions, Mental Illness and Medically Vulnerable

Populations (CHAMMP) at Harborview Medical Center, which is part of UW

Medicine.

The report was published in this month's Diabetes Care, a professional

journal of the American Diabetes Association.

This is the first known study, the research team believes, 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 ative 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, developed in 1994 by

and Bartholomew. 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.

Individuals with an interactive style find it easy to get close to others

and rely on them, and in turn are dependable for others. Those with an

independent style tend to be either dismissive or fearful of close

relationships. Some people with this style would like emotional closeness,

but find it hard to trust or depend on others. Others can be indifferent to

close relationships, preferring instead to be free and self-reliant.

" These ways of relating often extend to their relationships with health-care

providers, " the researchers said.

Regardless of their style, most patients Ciechanowski and his colleagues

have studied over several projects perceive health care as rushed,

impersonal and fragmented. Those with an independent style also reported

feeling threatened by the power health-care providers had. Some were highly

attuned to signs of rejection; others were sensitive to being controlled,

and at the same time worried that help would not be available for them.

Those with an independent style in relationships often felt a wall existed

between patients and providers.

Interactive patients tended to understand the pressures health professionals

were under, and overlooked minor shortcomings, previous research by

Ciechanowski and his team has found. Such patients were more likely to value

ongoing relationships with their providers, even when circumstances weren't

ideal, and respected their training and knowledge.

During the course of the most recent study, diabetes patients who were

mistrustful of people, including health-care providers, had a 33 percent

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.

The exact mechanisms behind the link between an independent relationship

style and a higher mortality rate are not yet known, the researchers said,

and further research is needed to delineate the reasons and to develop

effective interventions.

" Prior studies have shown that lower support seeking is associated with

poorer adherence to treatment, " Ciechanowski noted. 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 injectible 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, " Ciechanowski noted. Planning and cooking diabetic-friendly

meals, exercising, and quitting smoking are best undertaken, he added, with

motivational support. Also, as diabetes gets more severe or complications

arise, a self-reliant attitude that worked in the past may become a

liability.

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.

" Our research is based on a developmental theory known as attachment theory

where earlier experiences often shape an individual's ability to trust later

in life, " Ciechanowski explains.

" As clinicians, we have to keep in mind that what we say and how we say it

can make a big difference in trust between clinician and patient -- which

has implications for treatment adherence and health outcomes. Bedside manner

matters. Also, as stewards of health care, we have to be mindful about what

our fast-paced health-care system says to patients to engender trust or not.

Long waits, less face-to-face time with providers, rashly delivered health

information, and lack of continuous care can reduce trust -- particularly in

those with an independent relationship style. "

In addition to Ciechanowski, other researchers on the study " Relationship

Styles and Mortality in Patients with Diabetes " were Joan Russo and Wayne

Katon, UW Department of Psychiatry and Behavioral Sciences; H.B.

Lin, Evette Ludman, Heckbert, and Von Korff, Group Health

Research Institute, Seattle; Bessie Young, UW Department of Medicine; and

H. , Veterans Administration Puget Sound Health Care System,

Seattle.

Heckbert also has a faculty appointment in the UW Department of

Epidemiology, and Young has a VA Puget Sound appointment as well.

Ciechanowski is founder and CEO of Samepage, an educational company

dedicated to improving health-care communications for patients and for

providers.

The study was supported with a grant from the National Institute of Mental

Health at the National Institutes of Health. The principal investigator on

the grant is Dr. Von Korff.

Source: University of Washington