Research from the US shows that couples who participate in a diabetes intervention together have less emotional distress than those who participate alone
By Sienna Russell-Green 
Diabetes requires that the person with diabetes make significant behavioural changes that are likely to affect both the individual and their family members. Data from the DAWN2 Study  show that familial distress, especially about hypoglycaemia (low blood glucose), is high. Interestingly, some family members report positive effects of their family member having diabetes, such as leading them to make their own healthier lifestyle choices. Additionally, 39% of family members report that they wanted to be more involved in the care of the person with diabetes. This suggests that partners not only want to be more involved in care, but they could benefit too. Couples interventions may have beneficial effects on both the person with diabetes and their partners, providing mutual support for behaviour change.
The authors of this study  aimed to find whether partner involvement in a behavioural intervention for adults with type 2 diabetes had a beneficial effect on partners. This was broken down in two key aims:
- To compare outcomes of partners who participated with those of partners who were not involved in the intervention.
- To explore ‘ripple effects’, i.e. positive behaviour changes seen in partners who were not involved.
The study was a randomised trial comparing outcomes of a behavioural intervention delivered by telephone in three ways: Couples Calls (CC), Individual Calls (IC) and Diabetes Education Calls (DE). Couples included one partner with type 2 diabetes and HbA1c ≥7.5%. All groups received two self-management education calls. CC and IC groups received an additional 10 behaviour change calls. Assessments were conducted at 0, 4, 8 and 12 months. Partner outcomes measured were psychological (diabetes distress, relationship satisfaction, depressive symptoms), medical and behavioural.
A total of 268 partners took part. On average, they were 56 years of age; 65% were women, and 30% were from minority ethnic groups. The results showed that partners in the CC group (compared to IC and DE groups) had greater reductions in diabetes distress (4 and 8 months, p<0.001; 12 months, p<0.05). They also had improvements in short-term relationship satisfaction (<12 months) and fewer symptoms of depression at 12 months. There were no significant differences between groups in behavioural outcomes. There was no evidence of a ‘ripple effect’ on partners who had not been involved in the intervention, i.e. comparing partners in the IC and DE groups.
If high levels of partner distress were reported, there is concern that involving a partner could lead to more conflict. For example, negative reactions to perceived ‘miscarried helping’ (i.e. attempts to help that are not as helpful as intended). However, this study shows the opposite. If an intervention is focused on promoting collaboration, communal coping and emotional openness, then involving a partner may have beneficial emotional and relational effects.
Future research needs to explore how to enhance these positive emotional and relational changes to develop tailored interventions to support both the person with diabetes and their close family members.
Trief PM, Fisher L, Sandberg J, Hessler DM, Cibula DA & Weinstock RS. Two for one? Effects of a couples intervention on partners of persons with Type 2 diabetes: a randomized controlled trial.  Diabetic Medicine, 2019; 36 (4): 473-481.