"Prior studies have shown that lower support seeking is associated with poorer adherence to treatment," Ciechanowski noted. An independent relationship style, he explained, is often played out in missed appointments, higher glucose readings, lower satisfaction with health-care, and poorer home treatment of diabetes in such areas as foot care, exercise, diet, oral and injectible medication use, blood sugar monitoring, and smoking cessation.

"Many self-management behaviors related to diabetes are optimally carried out in collaboration with others -- family, peers and health-care providers," Ciechanowski noted. Planning and cooking diabetic-friendly meals, exercising, and quitting smoking are best undertaken, he added, with motivational support. Also, as diabetes gets more severe or complications arise, a self-reliant attitude that worked in the past may become a liability.

There are approaches, according to Ciechanowski, that health-care providers can try to improve collaboration with diabetes patients who have an independent relationship style, such as directly and non-judgmentally talking about this style. Also, providers might coach patients and help them set simple goals in seeking support in managing their diabetes. However, the effectiveness of such approaches in reducing the higher death rates among such patients has not yet been tested.

"Our research is based on a developmental theory known as attachment theory where earlier experiences often shape an individual's ability to trust later in life," Ciechanowski explains. "As clinicians, we have to keep in mind that what we say and how we say it can make a big difference in trust between clinician and patient -- which has implications for treatment adherence and health outcomes. Bedside manner matters. Also, as stewards of health care, we have to be mindful about what our fast-paced health-care system says to patients to engender trust or not. Long waits, less face-to-face time with providers, rashly delivered health information, and lack of continuous care can reduce trust -- particularly in those with an independent relationship style."

Source: University of Washington