With rapidly rising prevalence, diabetes mellitus presents an enormous challenge to healthcare, affecting 25.6 million adults, with 2 million new cases diagnosed annually. It costs a staggering $245 billion of US economy in 2012, which has risen from $174 billion in 2007. Of all cases, approximately 90% are in the form of type 2 diabetes mellitus (T2DM). The impact of T2DM and its treatment occur in an interpersonal and daily context. The medical regimen is demanding and stressful, affecting not only the patients but also their families, especially spouses. Successful T2DM management is a daily endeavor, requiring accommodations and adjustments from intimate partners. However, little is known how the daily stress experience and health behavior of both the patients and their spouses may influence patients' daily glycemic management. Furthermore, considering the recent research on health concordance and emotional transmission within couples, it is an intriguing hypothesis that the spouse's stress and health behavior may transmit to the patient and result in health consequences. In addition, there are several methodological issues in existing studies that weaken their inferences, including reliance on retrospective self-reports susceptible to systematic recall biases and memory failure, no data collected from spouses directly, use of between-person design to test within-person hypotheses, and lack of attention to the daily process of glycemic management. To address these problems and take advantage of the recent technological and methodological advancements, we propose to (1) evaluate the feasibility of using several electronic mobile devices and implementing daily diary and experience sampling method to collect real-time or daily data over 14 days from both patients and their spouses and store the data on a secure cloud computing platform, and (2) use the collected data to explore several within-couple dyadic hypotheses and establish appropriate data analytic strategy for future research. Specifically, we will investigate (1) whether the spouse's daily stress and health behavior (diet and physical activity), in addition to the patent's, influence the patient's daily glycemic management, and (2) whether there is emotional and behavioral transmissions from the spouse to patient such that the spouse's stress and health behavior on one day contribute to a similar pattern in the patient's stress and health behavior which then affect the patient's glycemic management on the same day or the following day. The findings will contribute to the establishment of innovative dyadic data collection and storage strategy to facilitate future research in real-time computing for timely patient feedback and intervention, and they will enhance the performance a prototype of diabetes monitoring system developed by our team to detect clinical problems. The results will also contribute to our long-term goal of developing innovative monitoring and intervention strategies that address critical interpersonal barriers to achieve successful T2DM management in daily marital context.

Public Health Relevance

Type 2 diabetes mellitus (T2DM) is a severe and costly chronic disease. It is affecting increasingly more people in the US. About 25 million adults are living with T2DM, with 2 million more newly diagnosed each year. The management of T2DM is complex and demanding, often causing stress on a daily basis not only for the patients but also for their spouses. However, little is known about how the spouse's daily stress and health behavior, in addition to the patient's, may affect patient's glucose control. This study will evaluate the use of several mobile devices, including smartphones, activity monitors, glucose sensors, and tablet computers, to collect daily information about stress, diet, and exercise from both patients and their spouses over 14 days. We will explore how the spouses' stress and health behavior may change the patients' and affect their glucose control on a daily basis. Results will provide valuable information for developing better strategies for diabetes management for couples by resolving obstacles in everyday interpersonal context.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-EMNR-K (80))
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Hunter, Christine
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University of Delaware
Schools of Arts and Sciences
United States
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