New study reveals lack of trust in healthcare providers puts diabetics' health at risk

NEW YORK Diabetics who are less inclined to seek help with managing their condition are at increased risk of premature death, a new study found.


Researchers led by Paul Ciechanowski, associate professor of psychiatry and behavioral sciences at the University of Washington, examined 3,535 adult patients with Type 1 and Type 2 diabetes enrolled as Group Health Cooperative patients in the Puget Sound area of Washington state. Because depression has been linked to premature death from diabetes, patients with depression were not included to avoid confounding the study results.



The patients completed a relationship questionnaire. Based on the results of this survey, patients were divided into two groups: those with an interactive style and those with an independent style in relating to people. Individuals with an interactive style find it easy to get close to others and rely on them, and in turn are dependable for others. Those with an independent style tend to be either dismissive or fearful of close relationships. Some people with this style would like emotional closeness, but find it hard to trust or depend on others. Others can be indifferent to close relationships, preferring instead to be free and self-reliant. These classifications, the researchers found, determined whether or not the study subjects' lives were cut short by their lack of trust of healthcare providers.



During the course of the most recent study, diabetes patients who were mistrustful of people, including healthcare providers, had a 33% higher mortality rate than those who interacted easily with others and sought comfort and support. The researchers found the significantly higher risk of death among diabetes patients who were less likely to seek support still held after controlling for other such potential risk factors for mortality as age, marital status, other medical conditions, complications of diabetes and body mass index.


Ciechanowski noted that the results of the study also depends on how healthcare providers approach their patients is crucial to patients' adherence and willingness to discuss their concerns.

"Prior studies have shown that lower support seeking is associated with poorer adherence to treatment," Ciechanowski said. "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 healthcare 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."

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