The Diabetes Attitudes Wishes and Needs (DAWN) study was groundbreaking at the time of its publication in 2001 because of its size, scope and international focus. The findings revolutionized diabetes self-management education. The findings of DAWN2 are no less important because they confirm and deepen understanding of diabetes-related distress, patient engagement and self-management behaviors.
DAWN2 examines psychosocial and self-management issues among people with diabetes, concerns of family members and perceptions of healthcare professional and health system issues. Martha M. Funnell, MS, RN, CDE, FAADE, associate research scientist in the Department of Learning Health Sciences at the University of Michigan Medical School in Ann Arbor, shared the results of DAWN2 during her Thursday morning keynote address, “A Decade of Progress Toward a New DAWN.”
While DAWN involved 5,426 adults with diabetes, 3,982 healthcare professionals and 13 countries, DAWN2 entailed 15,438 total respondents, including 8,596 individuals with diabetes, 2,057 family members, and 4,785 diabetes care professionals in 17 countries.
Since DAWN, emotional well-being has been incorporated into standards of care, including screening for psychological issues and continuous screening for depression and diabetes-related distress.
“As educators, we emphasize in the recommended content areas effective coping, problem-solving and behavior change,” Funnell said. “We’ve also learned, and incorporated into our standards, that ongoing self-management and support is critical in order for our patients to sustain the improvements they have made.
“So why did we need a new study? Well, because diabetes isn’t going away. Diabetes is becoming more prevalent, we’re expecting even more people with diabetes, and we need to do better job in helping if we’re going to help them have the best possible quality of life and outcomes.”
While DAWN relied on input from healthcare providers and people with diabetes, DAWN2 also included responses from adult family members of adults with diabetes.
In the U.S. arm of DAWN2, which had 940 total participants (539 people with diabetes, 121 family members and 280 healthcare professionals), 799 were minorities (537 people with diabetes, 122 family members and 140 healthcare professionals) who were African-Americans, Hispanics and Chinese-Americans. The U.S. DAWN2 data showed:
- Most people with diabetes want to improve self-management (eating and exercise habits).
- There is a substantial amount of diabetes distress among both family members and people with diabetes, and people with diabetes who are in minority groups experience more diabetes distress than non-Hispanic whites.
- Having a large social support network is related to better psychosocial outcomes for people with diabetes and their family members.
- Few people with diabetes let other people know how they can best support them in managing their diabetes or ask for support, especially non-Hispanic whites.
- Most people with diabetes are pleased with the level of involvement of their family in diabetes care, and family members want to help. They feel that family members listen to them when they talk about difficulties of living with diabetes.
“Diabetes is a burden in terms of managing the condition and psychologically. Encourage the person with diabetes to ask for support when it’s needed. Family members are a valued resource, but they may not have the knowledge, resources or skills to be truly helpful to that person with diabetes,” said Funnell, adding that diabetes educators should help make sure family members are supported.
While Funnell said she knows she has expertise in diabetes education, she also is fully aware that her patients also are experts.
“We all care deeply for our patients. The thing that continues to resonate every time I come to this meeting is the passion that we have,” she said. “Let’s use that passion to make life better for our patients and their families.”