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Family History Underused in Diabetes Prevention Efforts

Type 2 diabetes prevention programs aimed at high-risk individuals with a family history of the disease may underuse psychological and motivational strategies that emphasize genetic susceptibility.

Wieke Heideman, from VU University Medical Centre in Amsterdam, the Netherlands, and colleagues write, “To date, intervention studies so far did not address the unique challenges faced by people with a FH (family history) and its implications for educational strategies.”

“Findings from this review suggest that existing diabetes prevention programs, while aimed at relatives of type 2 diabetes patients, have not utilized the unique opportunities and challenges associated with FH and underlying hereditary factors,” the authors conclude.

Dr. Heideman and colleagues searched medical literature databases for studies aimed at diabetes prevention in people with a FH of the disease. They identified studies that met the inclusion criteria. The various interventions (diet, exercise, or both) were associated with generally beneficial changes in cardiovascular risk factors, serum insulin, or weight loss.

“Surprisingly, none of the six lifestyle programs mentioned specifically addressed the topic of FH of diabetes and related issues, such as causal beliefs and attitudes towards genetics, control beliefs, fatalism or anxiety,” note the authors.

“Apparently FH was merely used as an identifier for the purpose of recruitment for the studies, rather than as a vehicle for enhancing intrinsic motivation to make lifestyle changes,” they add.

They suggest that “addressing specific beliefs related to the vulnerability of these people, targeting health promotion programs and prevention strategies to relatives of type 2 diabetes patients, rather than ‘anyone at risk’ could help to enhance reach and effectiveness.”

However, on the basis of the findings of the review, the authors comment that it is still unclear how to best communicate risk information to family members of patients with diabetes and how such communications would differ from strategies used in people at risk without a FH.

Matti Uusitupa, MD, PhD, from Kuopio University Hospital in Finland, and Jaakko Tuomilehto, MD, MPolSc, PhD, from the University of Helsinki in Finland, noted that the Finnish Diabetes Prevention Study showed that although individuals with a FH initially showed better responses to interventions, longer follow-up showed that diabetes incidence was not affected by FH.

They suggest that potential motivation to make lifestyle changes might be higher in individuals with impaired glucose tolerance, rather than simply a positive FH of diabetes.

“Individuals with FH of diabetes, as well as others at high risk, should keep in their mind that their destiny regarding the possibility of becoming diabetic is not determined by factors related to the phenotype of their family members, but their destiny is much in their own hands (and feet),” the commentators write.

Primary Care Diabetes. 2011;5:215-221.