Diabetes is a condition that affects the entire family. Many aspects of daily living, such as eating, working, sleeping, physical activity, and stress management can be greatly impacted.

An approach I feel strongly about, and I think many of us have adopted, is to invite patients' family members and caregivers to group diabetes education sessions. Including caregivers in these sessions creates an environment in which all participants not only learn how to manage diabetes together, but also learn how to support each other.

I would like to advocate an even deeper approach to caregiver support: add a series of caregiver support sessions to your DSME program. The DAWN2™ study found that one-third of family members supporting a loved one with diabetes reported negative impacts to their well-being, finances, leisure activities, and physical health. Caregivers also experience high levels of distress and often worry about the risk of their loved ones experiencing hypoglycemic events.

The DAWN2™ results also found that many family members would like to be more involved in caring for their loved ones and want to better help them manage their disease.²

Here's a sample framework for a diabetes caregiver support group:

1. Establish the purpose of the session. You might say something like: "We're here to talk about your role as a caregiver in a healthy family—to help you become a better caregiver for yourself and for your loved one. We want to help you avoid burnout and damage to your relationship. The burden of living with diabetes can be as challenging for the caregiver as it is for the patient."
2. Allow each family member to discuss the challenges related to living with a person with diabetes. Sharing experiences and feelings aloud and with others in similar situations can help them normalize their feelings and get the support they need in order to re-focus on their loved ones. Challenges they bring up might include:
• How do I support someone without being too pushy/demanding?
• How can I heal with my support rather than damage our relationship?
3. Encourage them to discuss topics such as:
• How they deal with burnout
• Daily frustration
• Coping with trying to help someone who may not always want the help
4. Help participants with their communication skills, including how to frame their support. For example, instead of telling a loved one what to do, ask them: "What can I do today to make life easier for you?"
5. Spend time on the technical aspects of support, such as healthy eating and blood glucose monitoring, from the perspective of the caregiver role.

A healthy relationship between a person with diabetes and a caregiver is an investment in better outcomes.

What methods do you use to involve family members and caregivers in DSME?

1. Zarit, S. Assessment of Family Caregivers: A Research Perspective. In Family Caregiver Alliance (Eds.), Caregiver Assessment: Voices and Views from the Field. Report from a National Consensus Development Conference. 2006; Vol. II: 12-37.
2. Kovacs Burns K, et al. Diabetes Attitudes, Wishes and Needs second study (DAWN2): Cross-national benchmarking indicators for family members living with people with diabetes. Diabetic Medicine2013; 30(7):778-88.