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29-10-2019 | Diabetes prevention | Editorial | Article

The family and diabetes care: A multifaceted relationship

Author: Sanjay Kalra

The concept of family is central to our society. Indeed, a strong sense of family could be considered among the building blocks for harmony and happiness. The World Health Organization’s assertion that we can define health as a state of “complete physical, mental, and social well-being, not merely the absence of disease or infirmity,” lends credence to the suggestion that the family, and other similar relationships, can play a pivotal role in determining the health of an individual.

In recent years, the patterns and priorities of human health have changed dramatically. The definition of health, however, has stood the test of time. In 2018, the International Diabetes Federation (IDF) went one step further, and expanded the scope of diabetes care beyond the individual, centering their theme for World Diabetes Day on "The Family and Diabetes,” to reflect the importance of intra- and inter-family relationships in diabetes management.

Diabetes care is indeed characterized by multifaceted, multidirectional links to the family. The family and its associated environment can run the gamut from being a contributing factor to diabetes, up to and including a much-needed source of diabetes care. It also represents an opportunity for prevention of diabetes, both within the family, and in the larger community:

The “ABCD” of family and diabetes

Active opportunity for prevention of diabetes

  • Within the family
  • In progeny
  • In the community

Bystander victim

  • Emotional: compassion fatigue
  • Physical: needle stick injury
  • Social: social ostracization
  • Financial: extreme economic impact

Cause and precipitant

  • Genetic, eg, 
    • MODY
  • Lifestyle, eg,
    • eating patterns
    • stress levels
    • exposure to pollutants

Dynamic support system

  • Self-care and self-management
  • Adherence to healthy diet/lifestyle
  • Facilitation of healthcare seeking/access

The family as a cause and precipitant

Most families share genes as well as lifestyle. The family, therefore, can be a cause, or a precipitating factor, for diabetes.

Diabetes, being a genetically defined and a lifestyle disorder, runs in families. Clustering of various risk factors may be associated with a strong family history in type 2 diabetes. Apart from this, an increased prevalence of type 2 diabetes has been noted in the spouses of people with type 2 diabetes. Monogenic diabetes, including maturity-onset diabetes of young (MODY) and type 1 diabetes, are also characterized by family association.

The family as a bystander target

Diabetes not only affects the individual, but also his or her family. Management of diabetes involves significant changes in lifestyle, including eating patterns and recreation or physical activity choices. The entire family may have to modify its lifestyle to suit the needs of the person with diabetes.

In addition, there is often a need for family members to support the person with diabetes in their self-care and self-management routines. This may lead to physical as well as emotional fatigue, and is reflected in health hazards such as needle stick injuries and compassion fatigue.

Diabetes therapy can also be a major drain on financial resources, and may have a significant impact on financial wellbeing of the family.

The family as a dynamic support system

Diabetes self-care is a 24-7 job for the person living with the condition. Such care is not possible without a dynamic and proactive support system.

While diabetes care professionals do contribute, the bulk of support is provided by the family and other loved ones. The DAWN2 study demonstrated that family members of people with diabetes feel apprehensive about their inability to handle complications, but wish to involve themselves in care of their loved ones. Thus, the family represents a dynamic support system for diabetes care, which must be strengthened.

The family as an active area of opportunity

As we work to contain the diabetes pandemic, we are mindful of the fact that prevention, rather than cure, is the key to success. The family that lives with diabetes is fertile ground in which to sow the seeds of prevention.

Family members, who are already sensitized to the components of a healthy lifestyle regimen, can be encouraged to adopt the same for prevention of diabetes. Their voice and opinion can also be utilized to spread diabetes awareness in the community, and encourage primordial and primary preventive strategies in society.

Practice of healthy behaviors will facilitate overall health, and may translate into a reduced risk of diabetes not only in current, but also in future generations.


The family is one of the basic units of a society, and should be viewed as an interventional unit of diabetes care as well.  Both as an etiology and as a target, the family is implicated in the etiopathophysiology of diabetes. At the same time, however, the family that lives with diabetes is a support system for management as well as an opportunity for prevention of the syndrome.

Diabetes care professionals should therefore take proactive measures to involve the family in diabetes care, by addressing its needs, and leveraging its strengths.

About the author

Sanjay Kalra

Sanjay Kalra, MBBS MD DM (AIIMS New Delhi), is an endocrinologist based at Bharti Hospital, Karnal, India.

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