Spouses' attempts to regulate day-to-day dietary adherence among patients with type 2 diabetes

Objective: To investigate daily dietary adherence and diabetes-specific distress among older adults with type 2 diabetes mellitus (T2DM) as a function of spouses' diet-related support and diet-related control (persuasion and pressure) and whether these daily processes differ among couples who do and do not appraise responsibility for managing T2DM as shared. Methods: End-of-day diaries were completed by 126 couples in which one partner had T2DM (patient) and the other did not (spouse). Using electronic diary methods, each partner independently recorded data for 24 consecutive days (patients recorded their day's dietary adherence and diabetes-specific distress; spouses recorded their day's involvement in patients' dietary management). To assess dietary adherence, patients reported the extent to which they followed dietary recommendations that day with items from the Summary of Diabetes Self-Care Activities Measure. To assess diabetes-specific distress, patients reported the extent to which they worried about diabetes that day using items from the Problem Areas in Diabetes (PAID) scale. Results: Multilevel modeling revealed that, relative to the prior day, spouses' diet-related support was associated with increases in patients' adherence whereas dietrelated persuasion and pressure were associated with decreases in adherence; spouses' pressure was associated with increases in patients' diabetes-specific distress. When partners appraised responsibility for managing T2DM as shared, support was associated with decreases in diabetes-specific distress; pressure was associated with decreases in adherence. Conclusions: Our findings offer insight into partners' day-to-day disease-related interactions and identify those that are likely to be beneficial versus detrimental for patients' physical and psychological health.