Family involvement is helpful and harmful to patients' self-care and glycemic control

•Family involvement in adults' diabetes management can be both helpful and harmful.•Both supportive and obstructive behaviors were associated with patients' self-care.•Type mattered more than degree of family involvement for patients' self-care.•Obstructive behaviors were associated with worse HbA1C.•Supportive behaviors buffered this deleterious effect on HbA1C.

ObjectiveWe assessed the relationships between supportive and obstructive family behaviors and patients' diabetes self-care activities and HbA1C, and potential interaction effects and differences by demographic characteristics.MethodsIn a cross-sectional study, 192 adults with type 2 diabetes completed the Diabetes Family Behavior Checklist-II, the Summary of Diabetes Self-Care Activities, and a glycemic control (HbA1C) test.ResultsParticipants reported similar rates of supportive and obstructive behaviors that were positively correlated (rho = 0.61, p < 0.001). In adjusted analyses, supportive family behaviors were associated with adherence to different self-care behaviors (β = 0.20 to 0.50, p < 0.05), whereas obstructive family behaviors were associated with less adherence to self-care behaviors (β = −0.28 to −0.39, p < 0.01) and worse HbA1C (β = 0.18, p < 0.05). Supportive behaviors protected against the detrimental effect of obstructive behaviors on HbA1C (interaction β = −0.22, p < 0.001). Non-Whites reported more supportive and obstructive behaviors than Whites, but race did not affect the relationships between family behaviors and self-care or HbA1C.ConclusionInvolving family members in patients' diabetes management may impede patients' self-care and compromise their glycemic control unless family members are taught to avoid obstructive behaviors.Practice implicationsOur findings endorse interventions that help family members develop actionable plans to support patients' self-care and train them to communicate productively about diabetes management.