Pathway analysis of genome-wide association study on asthma

Objective

The aims of this study were to identify the candidate causal single nucleotide polymorphisms (SNPs) and candidate causal mechanisms of asthma and to generate SNP to gene to pathway hypotheses.

Methods

SNPs that met a threshold of p ? 0.001 in a genome-wide association study (GWAS) dataset of asthma, which included 292,443 SNPs in 473 asthma cases and 1892 controls, were used in the present study. Identify candidate causal SNPs and pathway (ICSNPathway) analysis was applied to this dataset.

Results

ICSNPathway analysis identified four candidate causal SNPs, four genes, and 21 candidate causal pathways, which in total provided four hypothetical biologic mechanisms: (1) rs7192 (nonsynonymous coding) to HLA-DRA to 21 pathways, such as, the role of eosinophils in the chemokine network of allergy, Th1/Th2 differentiation, and asthma (nominal p ? 0.001, FDR p ? 0.01); (2) rs20541 (nonsynonymous coding) to IL13 to asthma and cytokines and inflammatory response (nominal p < 0.001, FDR p ? 0.008); (3) rs1058808 (frameshift coding) to ERBB2 to transmembrane receptor activity (nominal p = 0.001, FDR p = 0.01); (4) rs17350764 (nonsynonymous coding (deleterious)) to OR52J3 to transmembrane receptor activity (nominal p = 0.001, FDR p = 0.01).

Conclusion

By applying ICSNPathway analysis to asthma GWAS data, we found four candidate causal SNPs, four genes involving HLA-DRA and IL-13, and four hypotheses, which may contribute to asthma susceptibility.     

Impact of genetic polymorphisms on the pathogenesis of idiopathic achalasia: Association with IL33 gene variant

Aim

To investigate the association of single nucleotide polymorphisms (SNPs) of genes involved in the regulation of immune responses, IL33, IL1RL1, IL23R, and IL10, with idiopathic achalasia in an Italian cohort of patients.

Materials and methods

A panel of eleven polymorphisms were genotyped in 116 unrelated idiopathic achalasic patients and 371 healthy subjects, by using TaqMan genotyping assays.

Results

Significant differences of allele (P = 0.0065, OR = 1.59, CI = 1.14–2.22) and genotype (P = 0.0097, OR = 1.74, CI = 1.14–2.65) frequencies of the IL33 rs3939286 variant were found between achalasic patients and controls. No association of the other investigated SNPs was detected. No differences in genotype and allele distribution were found with respect to clinical characteristics of patients.

Conclusion

We provide for the first time an association between the risk of developing idiopathic achalasia and IL-33 variant, underling the role of cytokines and inflammatory mediators on the pathogenesis of the disease.     

Associations between interleukin 1 polymorphisms and susceptibility to systemic lupus erythematosus: A meta-analysis

Objective

This study determined whether interleukin 1 (IL1) polymorphisms are associated with susceptibility to systemic lupus erythematosus (SLE).

Methods

A meta-analysis was conducted on the associations between the IL1A, IL1B, and IL1 receptor antagonist (IL1RN) polymorphisms and SLE.

Results

A total of 15 studies involving 1956 SLE cases and 2347 controls were included in the meta-analysis. The meta-analysis showed an association between SLE and the IL1A −889 T allele in the overall population and Europeans (OR = 0.858, 95% CI = 0.737–0.986, p = 0.032; OR = 0.827, 95% CI = 0.687–0.994, p = 0.043). Meta-analysis of the IL1RN polymorphism revealed an association with SLE in all study subjects (OR for IL1RN^∗2 = 1.539, 95% CI = 1.266–1.871, p = 1.5 × 10⁻²) and in Europeans and Asians (OR = 1.483, 95% CI = 1.187–1.852, p = 0.001; OR = 1.787, 95% CI = 1.167–2.736, p = 0.008). No associations were found between SLE and the IL1B −511 C/T, 3953 C/T, and IL1A +4845 G/T polymorphisms.

Conclusions

This meta-analysis suggests IL1A −889 C/T polymorphism is associated with susceptibility to SLE in Europeans, and that the IL1RN^∗2 allele is associated with susceptibility to SLE in Europeans and Asians.     

Low IL10 serum levels as key factor for predicting the sustained virological response to IFNα/ribavirin in Brazilian patients with HCV carrying IL28B CT/TT genotype

Propose

IL28B polymorphisms rs12979860 CC genotype was associated to protection of HCV infection and sustained virological response (SVR) in HCV infected patients treated with pegIFNα/ribavirin (IFNα/RIB), however, this polymorphism frequency varies depending on genetic components. Studies with larger number of Brazilian individuals, determining IL28B polymorphisms is lacking. Regarding to treatment response, the levels of IL10 seem to influence response to IFNα/RIB therapy. Thus, the IL28B polymorphism frequency was investigated in health controls and infected HCV patients, as well as, in patients who reach SVR vs Non-SVR. Also, to gain insight into the interplay between IL28B genotypes, IL10 levels and therapy response, a subgroup of genotyped HCV patients SVR and Non-SVR were analyzed regarding the IL10 production.

Methods

It was enrolled 487 HCV infected patients and 234 healthy individuals. Patients with response to IFNα/RIB were classified as SVR (n = 81) and Non-SVR (n = 123). TAQMAN probes were used for genotyping the SNP rs12979860, resulting in CC, CT or TT genotypes. In one hundred one patients, the levels IL10 were measured at week 4 of IFNα/RIB.

Results

CC genotype was associated to SVR (p = 0.029) and its frequency was higher in healthy individuals vs patients (p = 0.02). Patients carrying CT/TT with IL10 < 10 pg/mL, had a chance of 2.72 to achieve SVR in multivariate model (p = 0.043).

Conclusion

CC genotype was associated to SVR and protection to HCV infection. Moreover, IL28B genotyping and IL10 serum levels could be further explored as a useful algorithm for identify the CT/TT SVR patients.     

An updated meta-analysis to assess the effectiveness of psychological interventions delivered by psychological specialists and generalist clinicians on glycaemic control and on psychological status

Objective

To update a meta-analysis and determine the effectiveness of psychological interventions on glycaemic control measured by HbA_1c and psychological status in type 2 diabetes and to compare effects when interventions are delivered by generalist clinicians compared to psychological specialists.

Methods

We used the original review protocol and searched the Cochrane central register of controlled trials, Medline, Embase, PsychLIT, and Google Scholar from February 2003 (end of previous review) to March 2007. We extracted data on the participants, interventions, delivery methods, comparison groups and outcome measures.

Results

35 trials were reviewed and meta-analysis of 19 trials (n = 1431), reporting HbA_1c found a reduction in HbA_1c by 0.54% (−0.32; 95% CI: −0.47 to −0.16). In nine trials (n = 832) interventions were delivered by diabetes or general clinicians reducing HbA_1c by 0.51% (−0.27; 95% CI: −0.50 to 0.04). In nine trials, interventions (n = 561) were delivered by psychological specialists reducing HbA_1c by 0.57% (−0.36; 95% CI: −0.61 to 0.12). Meta-analysis of 13 trials reporting psychological status found psychological status to be lower in the intervention groups −0.56 (95% CI: 1.00 to −0.13). Trial quality for the majority of studies remained poor.

Conclusion

Our findings suggest that psychological and general clinicians are similarly effective in delivering psychological interventions, however, effect sizes for all clinicians have reduced since the earlier review.

Practice implications

Psychological training opportunities for generalist clinicians could lead to wider availability of effective psychological care.     

Carotid intima-media thickness and calcification in relation to bone mineral density in postmenopausal women—The OSTPRE-BBA study

Objectives

Atherosclerosis (AS) and osteoporosis are common diseases in elderly people and may be metabolically related. The aim of this cross-sectional population-based study was to explore the association between common carotid artery intima-media thickness (cIMT), carotid artery calcification (CAC), and BMD in postmenopausal women. In addition, the association of postmenopausal hormone therapy (HT) and selected diseases with cIMT and carotid calcification was studied.

Study design

The 290 women (mean age 73.6 years) included in this Bone Brain Atherosclerosis study (OSTPRE-BBA) were randomly selected from the population-based Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort, Finland.

Main outcome measures

For this cross-sectional study, cIMT was measured with B-mode ultrasound; femoral neck and total body BMD were measured with dual-energy X-ray absorptiometry.

Results

There were no statistically significant associations between mean cIMT and femoral neck T-score (p > 0.05). However, an increased maximum cIMT was significantly associated with low femoral neck T-score. In the osteoporotic group (T-score <−2.5, n = 20), the maximum cIMT was 2.51 ± 0.88 mm (mean ± SD); in the normal BMD group (T-score >−1, n = 122), it was 1.93 ± 0.64 mm (p = 0.001). The odds of having CAC were approximately four-fold higher in the osteoporotic group compared with the group with a normal femoral neck T-score (odds ratio [OR] = 4.2, p = 0.038). The maximum cIMT was smaller in HT users (1.98 ± 0.56 mm, n = 190) than in non-users (2.16 ± 0.74 mm, n = 156, p = 0.036).

Conclusions

The results of our population-based study suggest that BMD is related to AS, at least in carotid arteries. They indirectly support the hypothesis of partially shared pathophysiological mechanisms between these two disorders.     

Association of the FTO and ADRB2 genes with body composition and fat distribution in obese women

Objective

The aim of this study was to investigate whether the polymorphisms of the fat mass and obesity-associated gene (FTO, rs9939609:T > A) and the β2-adrenergic receptor gene (ADRB2, rs1042714:Gln > Glu) are associated with weight loss in dieting obese premenopausal women and the association of these SNPs with body weight, body composition and distribution of fat mass.

Methods

75 obese (BMI > 30) premenopausal women participated in the intervention including a 3-month weight reduction period and a subsequent 9-month weight maintenance period. Weight and height were measured and BMI calculated. Body composition and fat mass distribution were assessed by dual energy X-ray absorptiometry.

Results

At baseline, the AA homozygotes of the FTO gene were 10.1 kg heavier (p = 0.031), they had higher BMI (p = 0.038), and greater waist and greater hip circumference (p = 0.08 and p = 0.067, respectively) compared to the TT homozygotes. Gln/Gln carriers of the ADRB2 gene had smaller gynoid fat-% compared with both the Gln/Glu and Glu/Glu carriers (p = 0.050 and p = 0.009, respectively). The Gln homozygotes had also smaller total body fat-% and higher total body lean mass-% than that of the Glu homozygotes (p = 0.018 and p = 0.019, respectively).

Conclusion

FTO genotype was associated with body weight in general, whereas ADRB2 genotype was associated with fat distribution. However, all women in the study group lost weight similarly independently of their genotypes. Neither the FTO nor ADRB2 genotype had statistically significant effect on weight reduction or weight maintenance.     

Childhood adversity and pubertal timing: Understanding the origins of adulthood cardiovascular risk

Objective

To determine whether greater childhood adversity relates to younger menarcheal age; whether younger menarcheal age relates to increased CVD risk; and whether greater childhood adversity relates to increased CVD risk, directly or indirectly (mediated by menarcheal age).

Methods

Among 650 pre-menopausal women (ages 25–45; M = 34.9[5.6]), SEM was performed to estimate relations between childhood adversity, menarcheal age, and CVD risk.

Results

Results supported a covariate-adjusted model (RMSEA = 0.035; CFI = 0.983) in which greater childhood adversity was related to younger menarcheal age (β = −.13, p < .01) and younger menarcheal age was related to greater CVD risk (β = −.18, p < .05). Direct and indirect effects of childhood adversity on CVD risk were non-significant. Re-evaluation of the same model with additional covariate-adjustment for adulthood body composition showed the relation between menarcheal age and CVD risk attenuated (β = −.03, p = .376).

Conclusions

Cross-sectional evidence suggests family-related adversity experiences in childhood confer risk for earlier menarche which, in turn, relates to increased CVD risk in adulthood, possibly via post-pubertal body size.     

Participating in a virtual reality balance exercise program can reduce risk and fear of falls

Objective

The objective of this study was to quantify the effectiveness of virtual reality balance games (VRBG) to decrease risk and fear of falls among women.

Methods

Thirty six community dwelling women aged 56 and above were randomly divided into experimental (exercises using VRBG focus on improving balance) and control (conventional balance exercises) groups. Both groups attended a twice 6 weekly exercise session for an hour. Risk and fear of falls were measured with Physiological Profile Approach (PPA) and Activity Specific Balance Scale (ABC-6). Pre and post intervention differences between the groups were examined using two way repeated measures ANOVA.

Results

Both VRBG and conventional balance exercise groups had significant decrease in PPA (p < 0.001) and ABC-6 (p < 0.01) after the interventions. However, no significant effects were demonstrated between the groups in PPA (p = 0.18) and ABC-6 (p = 0.25) post intervention. Time and group interaction effect were not significant for PPA (p = 0.18) and ABC-6 (p = 0.45).

Conclusions

Practising VRBG can increase balance confidence and decrease risk of falls among community dwelling women.     

Inter-relation of Th1, Th2, Th17 and Treg cytokines in oral cancer patients and their clinical significance

Background

Altered cytokine production can lead to immune dysfunction in cancer patients. Hence, we investigated the cytokine balance in oral squamous cell carcinoma (OSCC) patients and their significance in providing new therapeutic insights.

Methods

We quantified Th17 (IL17A), Treg (TGFβ1), Th1 (IL2, IFNγ) and Th2 (IL4, IL10) like cytokines in the sera of 78 cases and 39 controls by ELISA. The intracellular expression of these cytokines was analyzed in 10 subjects from each group by flow cytometry.

Results

Serum levels of IL17A, TGFβ1, IL4 and IL10 were significantly higher while IL2 and IFNγ were relatively lower in patients as compared to controls. TGFβ1 (r = 0.55), IL4 (r = 0.75) and IL10 (r = 0.80) significantly (P < 0.0001) correlated with disease progression and their elevated levels showed increased odd ratios of approximately 18, 14 and 37, respectively. IL17A appeared as a risk factor (OR = 2.21, 95% CI = 0.89–5.42) although statistically insignificant. The levels neither correlated with disease progression nor with TGFβ1, IL4 and IL10 but showed positive association with IL2 (r = 0.51, P < 0.0001) and IFNγ (r = 0.24). Flow cytometry data also showed similar trend.

Conclusions

We reported a distinct TGFβ1 and Th2 (IL4, IL10) polarization with a borderline elevation of IL17A while, a suppression of Th1 (IL2, IFNγ) cytokines in OSCC patients.     

Evaluation of a treatment and teaching refresher programme for the optimization of intensified insulin therapy in type 1 diabetes

Objective

Evaluation of an ambulatory diabetes teaching and treatment refresher programme (DTTP) for the optimization of intensified insulin therapy in patients with type 1 diabetes (refresher course).

Methods

85 outpatients took part in this prospective multicentre trial. Metabolic and psychosocial data were analyzed at baseline (V1), 6 weeks (V2) and 12 months after DTTP (V3).

Results

In patients with baseline HbA1c > 7% (88%), HbA1c decreased by 0.36% (p = 0.004). The percentage of patients with HbA1c ≤ 7% increased from 21.3 to 34.9% and with HbA1c above 10% decreased from 6.6 to 1.6% at V3. The incidence of hypoglycaemia decreased significantly: non severe hypoglycaemia from 3.31 to 1.39 episodes/pat/week (p = 0.001) and severe hypoglycaemia from 0.16 to 0.03 episodes/pat/year (p = 0.02). The treatment satisfaction increased by +10 of maximal ±18 points. The negative influence of diabetes on quality of life decreased from −1.93 to −1.69 points (p = 0.031).

Conclusion

In a group of patients with moderately controlled diabetes type 1 who were already treated with intensified insulin therapy, metabolic control, treatment satisfaction and quality of life were improved after participation in an ambulatory DTTP without increasing insulin dosage, number of injections or insulin species.

Practice implications

This DTTP is effective for the optimization of intensified insulin therapy.     

Metabolic transitions at menopause: In post-menopausal women the increase in serum uric acid correlates with abdominal adiposity as assessed by DXA

Objectives

The present study aimed to investigate any associations between parameters of body fat mass distribution and levels of serum uric acid (sUA), a well-documented cardiovascular risk factor, among non-obese women ranging from pre- to post-menopausal status.

Methods

In this cross-sectional population-based study we assessed body fat distribution by dual-energy-X-ray absorptiometry (DXA), and sUA levels in 101 pre- and 134 post-menopausal non-obese apparently healthy women.

Results

Multivariate stepwise regression analysis revealed that sUA was independently associated to the indicators of overall fatness, i.e. body mass index (β = 0.339, p < 0.001) and DXA-assessed total and percentage body fat (β = 0.366, p < 0.001 and β = 0.412, p < 0.001, respectively), only among post-menopausal women. Within this sample subset, trunk (i.e. central) fat mass emerged as a strong predictor of sUA (β = 0.408, p < 0.001), after taking the potential confounders (including body mass index) into account.

Conclusion

Central fat accumulation was found to be independently associated with higher sUA levels among non-obese women in post- but not among those in pre-menopause.     

Évolution du nombre d’infections à Rotavirus et à virus respiratoire syncytial chez les enfants hospitalisés au CHU de Dijon entre 1998 et 2005

Aim

Respiratory syncytial virus (RSV) and Rotavirus infections represent up to 30% of cross infections in pediatric units. As they are a major public health problem, we studied their evolution and distribution at the Dijon University Hospital.

Population and methods

This exhaustive retrospective study included children under 15 with a new Rotavirus or RSV infection who were hospitalised at the Dijon University Hospital between 1998 and 2005. The general trend was determined by using moving averages, and the Spearman correlation coefficient r_s was calculated.

Results

From 1998 to 2005, 1886 new RSV (n = 981) or Rotavirus (n = 905) infections were identified in hospitalised children. The number of the infections decreased significantly, both for RSV (r_s = −0.71 ; p < 0.0001) and for Rotavirus (r_s = −0.77 ; p < 0.0001). Almost half of Rotavirus infections were nosocomial (46.3%) vs 5.3% of RSV infections, p < 0.0001. There was no significant difference in the proportion of RSV nosocomial infections between the epidemic and non-epidemic period (4.9% of nosocomial infections vs 7.1% respectively, p = 0.25). Rotavirus nosocomial infections were less frequent in epidemic period (41.6%) than in non-epidemic period (54.6%); p = 0.0002.

Conclusion

RSV and Rotavirus infections significantly decreased between 1998 and 2005. Proportion of RSV or Rotavirus infections didn’t increase in epidemic period, which could be explained both by an increased attention from healthcare professionals and by the effectiveness of hygiene measures taken.     

Long-term effect of communication training on the relationship between physicians’ self-efficacy and performance

Objective

To examine the long term impact of a communication skills intervention on physicians’ communication self-efficacy and the relationship between reported self-efficacy and actual performance.

Methods

62 hospital physicians were exposed to a 20-h communication skills course according to the Four Habits patient-centered approach in a crossover randomized trial. Encounters with real patients before and after the intervention (mean 154 days) were videotaped, for evaluation of performance using the Four Habits Coding Scheme. Participants completed a questionnaire about communication skills self-efficacy before the course, immediately after the course, and at 3 years follow-up. Change in self-efficacy and the correlations between performance and self-efficacy at baseline and follow-up were assessed.

Results

Communication skills self-efficacy was not correlated to performance at baseline (r = −0.16; p = 0.22). The association changed significantly (p = 0.01) and was positive at follow-up (r = 0.336, p = 0.042). The self-efficacy increased significantly (effect size d = 0.27). High performance after the course and low self-efficacy before the course were associated with larger increase in communication skills self-efficacy.

Conclusion

A communication skills course led to improved communication skills self-efficacy more than 3 years later, and introduced a positive association between communication skills self-efficacy and performance not present at baseline.

Practice implications

Communication skills training enhances physicians’ insight in own performance.     

SNP/haplotype associations of CCR2 and CCR5 genes with severity of chagasic cardiomyopathy

Background

Chronic inflammation plays a major role in the tissue injury seen in the chronic chagasic cardiomyopathy. The CCR2 and CCR5 chemokine receptors are involved with the type of cellular infiltrate present in cardiac tissue and CCR5-gene variants were previously associated with this pathology.

Methods and results

This is a replication study in an independent cohort with larger sample size. Nine SNPs of CCR5 and CCR2 were typified to confirm the association previously found with Chagas disease. Evidence of association with severity was found for the A allele of rs1799864 of CCR2 (p_ad = 0.02; OR = 1.91, 95% CI = 1.10–3.30), the T allele of the rs1800024 of CCR5 (p_ad = 0.01; OR = 1.95, 95% CI = 1.13–3.38), and the HHF^∗2 haplotype (p = 0.03, OR = 1.65, 95% CI = 1.03–2.65). These results were replicated in the study combined with previous data. In this analysis it was replicated the allele T of rs2734648 (p_ad = 0.009, OR = 0.52, 95% CI = 0.32–0.85) with protection. In addition, the allele G of rs1800023 (p_ad = 0.043, OR = 0.61, 95% CI = 0.38–0.98), and the HHC haplotype (p = 0.004, OR = 0.62, 95% CI = 0.44–0.86) were also associated with protection. In contrast, the allele A of rs1799864 of CCR2 (p_ad = 0.009; OR = 1.90, 95% CI = 1.17–3.08); and the allele T of rs1800024 of CCR5 (p_ad = 0.005, OR = 1.98, 95% CI = 1.22–3.23) were associated with greater severity. No evidence of association between symptomatic and asymptomatic patients was observed.

Conclusions

These results confirm that variants of CCR5 and CCR2 genes and their haplotypes are associated with the severity but not with susceptibility to develop chagasic cardiomyopathy.     

Mastery and perceived autonomy support are correlates of Dutch diabetes patients’ self-management and quality of life

Objective

The aim of this study was to assess the associations between type 2 diabetes patients’ mastery and perceived autonomy support and their self-management skills and health-related quality of life (HRQOL).

Methods

A cross-sectional questionnaire survey was conducted among 3352 patients with type 2 diabetes. Key variables were assessed with validated questionnaires.

Results

Patients’ mastery and perceived autonomy support correlated positively with their self-management skills (r = 0.34, p < 0.001; r = 0.37, p < 0.001) and HRQOL (r = 0.37, p < 0.001; r = 0.15, p < 0.001). In the linear regression analysis, mastery and perceived autonomy support were positive correlates of self-management (β = 0.23; p < 0.001; β = 0.25; p < 0.001). Patients with more physical or psychological complications had significantly lower scores on mastery, perceived autonomy support, self-management and HRQOL.

Conclusion

Our results indicate the importance of mastery in relation to diabetes patients’ perceived autonomy support, self-management skills and HRQOL.

Practice implications

Since a greater sense of mastery is likely to increase patients’ autonomous motivation to cope with their disease, interventions can aim to influence patients’ motivational regulation. In addition, we confirmed the need for autonomy support to improve patients’ self-management skills. Professionals can be trained to be autonomy-supportive, which relates to person-centered approaches such as motivational interviewing (MI).     

Patient knowledge and recall of health information following exposure to “facts and myths” message format variations

Objective

To assess if exposure to varying “facts and myths” message formats affected participant knowledge and recall accuracy of information related to influenza vaccination.

Methods

Consenting patients (N = 125) were randomized to receive one of four influenza related messages (Facts Only; Facts and Myths; Facts, Myths, and Refutations; or CDC Control), mailed one week prior to a scheduled physician visit. Knowledge was measured using 15 true/false items at pretest and posttest; recall accuracy was assessed using eight items at posttest.

Results

All participants’ knowledge scores increased significantly (p < 0.05); those exposed to the CDC Control message had a higher posttest knowledge score (adjusted mean = 11.18) than those in the Facts Only condition (adjusted mean 9.61, p = <0.02). Participants accurately recalled a mean of 4.49 statements (SD = 1.98). ANOVA demonstrated significant differences in recall accuracy by condition [F(3, 83) = 7.74, p < .001, η² = 0.22].

Conclusion

Messages that include facts, myths, and evidence to counteract myths appear to be effective in increasing participants’ knowledge. We found no evidence that presenting both facts and myths is counterproductive to recall accuracy.

Practice implications

Use of messages containing facts and myths may engage the reader and lead to knowledge gain. Recall accuracy is not assured by merely presenting factual information.     

Family involvement is helpful and harmful to patients’ self-care and glycemic control

Objective

We assessed the relationships between supportive and obstructive family behaviors and patients’ diabetes self-care activities and HbA_1C, and potential interaction effects and differences by demographic characteristics.

Methods

In a cross-sectional study, 192 adults with type 2 diabetes completed the Diabetes Family Behavior Checklist-II, the Summary of Diabetes Self-Care Activities, and a glycemic control (HbA_1C) test.

Results

Participants reported similar rates of supportive and obstructive behaviors that were positively correlated (rho = 0.61, p < 0.001). In adjusted analyses, supportive family behaviors were associated with adherence to different self-care behaviors (β = 0.20 to 0.50, p < 0.05), whereas obstructive family behaviors were associated with less adherence to self-care behaviors (β = −0.28 to −0.39, p < 0.01) and worse HbA_1C (β = 0.18, p < 0.05). Supportive behaviors protected against the detrimental effect of obstructive behaviors on HbA_1C (interaction β = −0.22, p < 0.001). Non-Whites reported more supportive and obstructive behaviors than Whites, but race did not affect the relationships between family behaviors and self-care or HbA_1C.

Conclusion

Involving family members in patients’ diabetes management may impede patients’ self-care and compromise their glycemic control unless family members are taught to avoid obstructive behaviors.

Practice implications

Our findings endorse interventions that help family members develop actionable plans to support patients’ self-care and train them to communicate productively about diabetes management.