This 4 year, longitudinal, randomized clinical trial tests the effect of two interventions on quality of family relationships, treatment adherence and metabolic control in 150 community residing, elderly black diabetics. Subjects and their families will be followed for up to 18 months. At baseline quantitative data will be collected about family relationships (social network; family ambiguity, closeness, cohesion and adaptability, psychological adjustment to illness, and depression), patients' perception of illness effect, adherence to medication and diet regimen, and metabolic control (Hemoglobin AL2). Subjects will be randomly assigned to two treatment groups: a family-centered intervention comprised of educational, family, and affective content delivered over 8 sessions; and a patient-centered intervention consisting of education, knowledge and skills instruction, goal setting and contracting, self-monitoring behaviors, and reinforcement strategies delivered over 8 sessions. A control group will receive customary care. All subjects and families will be reassessed immediately following the intervention, and at 3 and 6 months. Half the subjects (n=75) will also be reassessed at 18 months. The research questions are: 1. What are the characteristics of families caring for community residing, elderly black diabetics? 2. What is the correlation between the quality of family relationships and elderly diabetic patients' adherence to treatment and metabolic control? 3. Is participation by family. members and elderly black diabetics in a family-centered intervention associated with immediate improvements in the quality of family relationships, improvements in patients' perception of illness effect, and improved treatment adherence and metabolic control as compared to customary care? 4. Is participation by family members and elderly black diabetics in patient-centered care associated with immediate improvement in the quality of family relationships, patients' perception of illness effect, and treatment adherence and metabolic control as compared to customary care? 5. Is participation by family members and elderly black diabetics in a family-centered intervention associated with immediate improvement in the quality of family relationships, patients' perception of illness effect, and treatment adherence and metabolic control as compared to patient-centered care? 6. Are benefits from family-centered and patient-centered interventions maintained over time?
