Published online September 5, 2007
Diabetes Care
30:3033-3034,
2007
DOI: 10.2337/dc07-0688
© 2007 by the American Diabetes Association
Clinical Care/Education/Nutrition/Psychosocial Research
Original Research |
Perception of Offspring Risk for Type 2 Diabetes Among Patients With Type 2 Diabetes and Their Adult Offspring
Masakazu Nishigaki, RN, MHLTHSC1,
Koji Kobayashi, RN, PHD1,
Takako Hitomi, RN, MHLTHSC1,
Taeko Yokomura, RN2,
Mitsunao Yokoyama, MD, PHD2,
Naoto Seki, MD, PHD2 and
Keiko Kazuma, RN, PHD1
1 Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
2 Social Insurance Funabashi Central Hospital, Chiba, Japan
Address correspondence and reprint requests to Masakazu Nishigaki, Department of Adult Nursing, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan. E-mail: nishigaki-tky{at}umin.ac.jp
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INTRODUCTION
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Relatives of type 2 diabetic patients are at higher risk for type 2 diabetes, as they are likely to share genetic predisposition and have similar lifestyle habits (1). To actively involve high-risk individuals in prevention, recognition of disease risk is crucial (2). Some studies have suggested that Japanese are genetically predisposed to diabetes (3,4), so recognition of risk by high-risk Japanese individuals is particularly important. In addition, patients with diseases involving genetic predisposition need to advise and warn their offspring about risks associated with the disease (5,6). Diabetic parents must therefore recognize the high-risk status of their offspring, but no studies have examined risk perception of parents and their offspring in Japan.
This self-administered questionnaire survey was conducted to clarify perceptions of Japanese type 2 diabetic patients regarding risk of diabetes in their offspring, as well as perceptions of adult offspring about their own risk for diabetes.
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RESEARCH DESIGN AND METHODS—
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Subjects in the present study comprised 164 pairs of type 2 diabetic patients (aged <75 years) receiving treatment at a general hospital's diabetes clinic located in the suburbs of Tokyo, Japan, and their offspring (aged  20 but <50 years with no diabetes or glucose intolerance). After obtaining written informed consent to participate in the study, the patient and offspring completed an anonymous questionnaire separately, with a unique ID to identify each parent/offspring pair. The present study was conducted from October to December 2005. The ethical committee of the University of Tokyo approved all study protocols.
The perception of offspring risk for type 2 diabetes was assessed among both patients and offspring as "the likelihood of your offspring/you developing diabetes in comparison to the general Japanese population." The likelihood was evaluated from three perspectives: risk due to current lifestyle, risk due to family history, and overall risk. Response categories for each ranged from 1 ("very likely") to 5 ("very unlikely"). Results were tabulated; then, interperspective comparison in each group and pairwise comparison in each parent/offspring pair for risk perception were conducted.
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RESULTS—
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Backgrounds of subjects were as follows: male ratio in patients and offspring 54.3 and 40.2% (P = 0.01,  2 test), respectively; mean ± SD age 64.0 ± 6.5 and 33.4 ± 7.6 years; mean BMI 24.0 ± 3.6 and 22.9 ± 3.8 kg/m2 (P < 0.01, t test); mean educational years 12.6 ± 2.6 and 14.3 ± 1.9 years; and 58.5% of pairs were living together. Among patients, 23.2% were receiving insulin therapy, and 26.2% reported diabetes-related complications.
About 40% of patients stated that their offspring were more likely to develop diabetes from the perspective of lifestyle habits and about one-half from the perspective of family history and an overall view. No interperspective differences in risk perception were seen. Among offspring, about one-half recognized that they were at higher risk for diabetes compared with the general population from the perspective of lifestyle habits and 63.5% from an overall view. A higher risk from the perspective of family history was recognized by 74% of offspring, representing significantly higher risk perception compared with the other two perspectives (vs. lifestyle, P < 0.001; vs. overall view, P < 0.01; Steel-Dwass test for multiple comparisons) (Table 1).
Pairwise comparison showed that offsprings’ perception of their risk related to family history and their overall risk was significantly higher than their parents’ (P < 0.001, Wilcoxon's sign-rank sum test), but no difference was found in perception of lifestyle-related risk.
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CONCLUSIONS—
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In the present study, perceptions of risk for diabetes among offspring were higher compared with previous research involving both patients and offspring (7–9). Two possible causes may contribute to this higher risk perception. First, optimistic biases about risk perception and cross-cultural variations might exist between current and previous research. Many studies have described people underestimating risks of unfavorable events, representing optimistic bias (10). In addition, some research has shown cultural variations in optimism, with Western people more optimistic than Oriental people (11). These factors were related to lower risk perception in previous Western research. However, a previous study in Korea showed much lower risk perception than that seen in the present research (12), suggesting that the present subjects still display relatively high risk perception even after considering possible pessimistic trends in Asian countries. Secondly, an increasing awareness of diabetes may have affected this result. The present results are comparable with figures obtained from patients educated about genetic risks (13). In Japan, studies on genetic predispositions for diabetes have been conducted as part of national projects since 2000 (4,14), and the mass media has been actively reporting lifestyle diseases such as metabolic syndrome. The present results could indicate that these national projects have successfully raised awareness of diabetes among the Japanese population.
This study also clarified marked differences in risk perception between diabetic parents and offspring from both quantitative and qualitative perspectives. Offspring displayed greater recognition of diabetes risks than parents, contradicting a perception by health care professionals that offspring view diabetes as something that does not concern them (15). More interestingly, interperspective differences were found between patients and offspring as qualitative differences in risk perception. Patients perceived diabetes risks for offspring as equally low for lifestyle-related and hereditary risk, whereas offspring perceive hereditary risk as much higher than lifestyle-related risk. This may reflect self-serving thinking among both patients and offspring. Parents would feel guilty about passing susceptibility for a disease to their children (16), thus probably downplaying hereditary risk to reduce feelings of guilt about genetic predisposition toward diabetes. Conversely, offspring downplay their own responsibility by emphasizing hereditary risks more than lifestyle-related risks. These findings have some implications: if patients are to inform their offspring about disease risks more effectively, their own potential feelings of guilt need to be tackled first. If offspring are to take a more active stance toward prevention, realization of the importance of their own actions is particularly important in terms of risk.
Whether these findings are specific to Japanese diabetic patients and their offspring remains unclear, due to a limitation of this study: not containing a control group of nondiabetic adults. Further research investigating risk perceptions in the Japanese general population is needed to confirm and clarify these findings.
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Footnotes
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Published ahead of print at http://care.diabetesjournals.org on 5 September 2007. DOI: 10.2337/dc07-0688.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
Received for publication April 9, 2007.
Accepted for publication August 24, 2007.
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References
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- Kuzuya T, Matsuda A: Family histories of diabetes among Japanese patients with type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes. Diabetologia 22:372–374, 1982[Medline]
- Rosenstock IM: Why people use health services. Milbank Mem Fund Q 44 (Suppl.):94–127, 1966[Medline]
- Matsuoka K: Genetic and environmental interaction in Japanese type 2 diabetics. Diabetes Res Clin Pract 50(Suppl. 2):S17–S22, 2000
- Kadowaki T, Hara K, Yamauchi T, Terauchi Y, Tobe K, Nagai R: Molecular mechanism of insulin resistance and obesity. Exp Biol Med (Maywood ) 228:1111–1117, 2003[Abstract/Free Full Text]
- Weil J: Psychosocial Genetic Counseling. New York, Oxford University Press, 2000
- Wilson BJ, Forrest K, van Teijlingen ER, McKee L, Haites N, Matthews E, Simpson SA: Family communication about genetic risk: the little known. Community Genet 7:15–24, 2004[Medline]
- Farmer AJ, Levy JC, Turner RC: Knowledge of risk of developing diabetes mellitus among siblings of type 2 diabetic patients. Diabet Med 16:233–237, 1999[Medline]
- Pierce M, Harding D, Ridout D, Keen H, Bradley C: Risk and prevention of type II diabetes: offspring's views. Br J Gen Pract 51:194–199, 2001[Medline]
- Pierce M, Hayworth J, Warburton F, Keen H, Bradley C: Diabetes mellitus in the family: perceptions of offspring's risk. Diabet Med 16:431–436, 1999[Medline]
- Weinstein ND: Optimistic biases about personal risks. Science 246:1232–1233, 1989[Free Full Text]
- Heine SJ, Lehman DR: Cultural variation in unrealistic optimism: does the west feel more vulnerable than the east? J Pers Soc Psychol 68:595–607, 1995
- Kim J, Choi S, Kim CJ, Oh Y, Shinn SH: Perception of risk of developing diabetes in offspring of type 2 diabetic patients. Korean J Intern Med 17:14–18, 2002[Medline]
- Gnanalingham MG, Manns JJ: Patient awareness of genetic and environmental risk factors in non-insulin-dependent diabetes mellitus–relevance to first-degree relatives. Diabet Med 14:660–662, 1997[Medline]
- Nishigaki M, Kobayashi K, Shibayama T, Kadowaki T, Kazuma K: [Attitude of diabetes care specialists to prevention of diabetes to relatives of patients with type 2 diabetes]. J Jpn Diabetes Soc 49:669–676, 2006 [in Japanese]
- Haga H, Yamada R, Ohnishi Y, Nakamura Y, Tanaka T: Gene-based SNP discovery as part of the Japanese Millennium Genome Project: identification of 190,562 genetic variations in the human genome: single-nucleotide polymorphism. J Hum Genet 47:605–610, 2002[Medline]
- Chapple A, May C, Campion P: Parental guilt: the part played by the clinical geneticist. J Genet Couns 4:179–191, 1995
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INTRODUCTION
RESEARCH DESIGN AND METHODS--