Is the risk of diabetes greater if your spouse is diabetic?
The continuing increase of diabetes places a demand on healthcare providers to identify risk factors in order to promote health.
It is well known that socio-economic factors play a role in diabetes and that a family history of diabetes increases risk.
However, there was less evidence around possible increased risk of having a biologically unrelated family member with diabetes.
This systematic review sought cross-sectional, case-control and cohort studies that examined spousal association for diabetes or pre-diabetes.
Six studies with a total of 75,498 couples with a mean age of 52-74 years, were included in the systematic review.
The review found that there was a significantly higher risk of diabetes for people with a diabetic spouse.
This study has important implications for clinicians involved with patients with diabetes, especially in light of evidence that links obesity and diabetes.
Previous studies have reported that if one spouse becomes obese, there is a greatly increased likelihood that the other spouse will also become obese.
Since there are close links between diabetes and obesity, this issue needs consideration although obesity does not fully explain the link between both spouses developing diabetes.
Other unhealthy habits such as an unhealthy diet, smoking and physical inactivity may also be important.
A commentary notes that in clinical practice, recognising that there is a shared risk of diabetes in couples where one partner has diabetes or pre-diabetes may help couples cooperate and collaborate towards healthier behaviour to try to prevent diabetes.
Clinicians should encourage couple-based health promotion interventions. It may also be appropriate to screen spouses of people with diabetes to allow for early detection of diabetes.
Do public health campaigns that aim to reduce antibiotic use work?
Antibiotic resistance continues to be an issue of concern and there is an ongoing effort to reduce the inappropriate prescribing of antibiotics. The majority of antibiotic prescribing occurs in primary care, mostly for respiratory tract infections where it is unlikely this brings any benefits.
Patient expectations and demands are often cited as the driver behind antibiotic prescribing, so public health initiatives to curb antibiotic prescription demands are seen as one way to address the problem.
This Italian non randomised controlled trial sought to evaluate the effectiveness of a local public information campaign. A public health campaign that focussed mainly on the use of antibiotics for upper respiratory tract infections was run in two north Italian provinces.
The campaign ran for four months. Local doctors were involved in the development of the campaign that included posters, brochures, a local newsletter and mass media.
The antibiotic prescribing rate in these two provinces was compared to the prescribing rate in other provinces that had not run the campaign. The researchers also gathered data about public knowledge and attitudes to antibiotic prescribing.
The study found a 12% reduction in antibiotic prescribing in the provinces that had run the campaign compared to prescribing levels for the previous year. They also found a smaller 4.3% reduction in prescribing levels for the provinces with the campaign compared to those without.
A commentary notes that although this study has some methodological weaknesses, the campaign did seem to achieve a small reduction in antibiotic prescribing levels.
This result is in line with previous studies and it should be noted that even small reductions may be cost effective. However, public campaign interventions are complex and it can be difficult to determine the most effective elements of the campaign.
It is suggested that clinicians’ behaviour may be most important as although patient pressure can influence prescribing, ultimately it is clinicians who prescribe antibiotics.
It is possible that clinicians may be making incorrect assumptions about patient expectations so campaigns that focus on clinician behaviour may be more cost-effective.
Formoso G, Paltrinieri B, Marata AM, et al. Feasibility and effectiveness of a low cost campaign on antibiotic prescribing in Italy: community level, controlled, non randomised trial. BMJ 2013; 347:f5391.
Leong A, Rahme E, Dasgupta K. Spousal diabetes as a diabetes risk factor: a systematic review and meta-analysis. BMC Med 2014;12:12.
Chaput J-P. Diabetes risk increased between spouses. Evidence Based Nursing 2015 January; 18, 1 p 28
Francis N. A local public campaign reduces outpatient antibiotic prescribing in Italy Evidence Based Nursing 2015 January; 18, 1 p 27
PhD DN RGN
Lecturer in Community Nursing
School of Healthcare, University of Leeds
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