The Experience of Partners of Adults with Type 1 Diabetes: an Integrative Review


Purpose of Review

The purpose of this review was to synthesize the research on the experience of partners living with adults with type 1 diabetes (T1D).

Recent Findings

Eleven studies were included in the review. Three themes on the experience of living with a person with T1D were identified: the undercurrent of hypoglycemia, partners’ involvement in diabetes care, and the impact on partners’ lives. Due to considerable fear of hypoglycemia, partners had pervasive and deliberate ways in which they made attempts to minimize hypoglycemia in the person with diabetes and its cascade to a health emergency. As a result, partners of adults with T1D experienced considerable distress and disrupted lives. Partners also expressed a need for more support from family, friends, and health professionals.


Research is needed on the partner experience across the lifespan and the specific supportive services they need in order to optimize their health outcomes.

This is a preview of subscription content, log in to check access.

Fig. 1


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.

    Type 1 Diabetes Facts. Juvenile Diabetes Research Foundation website. Accessed November 27 2017.

  2. 2.

    Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics-2017 Update: a report from the American Heart Association. Circulation. 2017;135(10):e146–603.

    PubMed  Article  PubMed Central  Google Scholar 

  3. 3.

    Snell-Bergeon JK, Nadeau K. Cardiovascular disease risk in young people with type 1 diabetes. J Cardiovasc Transl Res. 2012;5(4):446–62.

    PubMed  Article  Google Scholar 

  4. 4.

    Secrest AM, Becker DJ, Kelsey SF, Laporte RE, Orchard TJ. Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes. Diabetes. 2010;59(12):3216–22.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  5. 5.

    Wong ND, Zhao Y, Patel R, Patao C, Malik S, Bertoni AG, et al. Cardiovascular risk factor targets and cardiovascular disease event risk in diabetes: a pooling project of the atherosclerosis risk in communities study, multi-ethnic study of atherosclerosis, and Jackson heart study. Diabetes Care. 2016;39(5):668–76.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  6. 6.

    Livingstone SJ, Levin D, Looker HC, Lindsay RS, Wild SH, Joss N, et al. Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008-2010. JAMA. 2015;313(1):37–44.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  7. 7.

    McCarthy MM, Whittemore R, Grey M. Physical activity in adults with type 1 diabetes. Diabetes Educ. 2016;42(1):108–15.

    PubMed  Article  Google Scholar 

  8. 8.

    Nefs G, Bevelander S, Hendrieckx C, Bot M, Ruige J, Speight J, et al. Fear of hypoglycaemia in adults with type 1 diabetes: results from diabetes MILES—the Netherlands. Diabet Med. 2015;32(10):1289–96.

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Trief PM, Xing D, Foster NC, Maahs DM, Kittelsrud JM, Olson BA, et al. Depression in adults in the T1D exchange clinic registry. Diabetes Care. 2014;37(6):1563–72.

    PubMed  Article  Google Scholar 

  10. 10.

    Marathe PH, Gao HX, Close KL. American Diabetes Association standards of medical Care in diabetes 2017. J Diabetes. 2017;9(4):320–4.

    PubMed  Article  Google Scholar 

  11. 11.

    Balfe M, Brugha R, Smith D, Sreenan S, Doyle F, Conroy R. Why do young adults with type 1 diabetes find it difficult to manage diabetes in the workplace? Health Place. 2014;26:180–7.

    PubMed  Article  Google Scholar 

  12. 12.

    Balfe M, Doyle F, Smith D, Sreenan S, Brugha R, Hevey D, et al. What’s distressing about having type 1 diabetes? A qualitative study of young adults’ perspectives. BMC Endocr Disord. 2013;13:25.

    PubMed  Article  PubMed Central  Google Scholar 

  13. 13.

    Miller KM, Foster NC, Beck RW, Bergenstal RM, DuBose SN, DiMeglio LA, et al. Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D exchange clinic registry. Diabetes Care. 2015;38(6):971–8.

    PubMed  Article  Google Scholar 

  14. 14.

    Nielsen HB, Ovesen LL, Mortensen LH, Lau CJ, Joensen LE. Type 1 diabetes, quality of life, occupational status and education level—a comparative population-based study. Diabetes Res Clin Pract. 2016;121:62–8.

    PubMed  Article  Google Scholar 

  15. 15.

    Chaytor NS. Cognition in adults and older adults with type 1 diabetes: chicken or egg? Diabetes Spectr. 2016;29(4):219–24.

    PubMed  Article  PubMed Central  Google Scholar 

  16. 16.

    Dhaliwal R, Weinstock RS. Management of type 1 diabetes in older adults. Diabetes Spectr. 2014;27(1):9–20.

    PubMed  Article  PubMed Central  Google Scholar 

  17. 17.

    DuBose SN, Weinstock RS, Beck RW, Peters AL, Aleppo G, Bergenstal RM, et al. Hypoglycemia in older adults with type 1 diabetes. Diabetes Technol Ther. 2016;18(12):765–71.

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    McCrimmon RJ, Sherwin RS. Hypoglycemia in type 1 diabetes. Diabetes. 2010;59(10):2333–9.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  19. 19.

    Weinstock RS, DuBose SN, Bergenstal RM, Chaytor NS, Peterson C, Olson BA, et al. Risk factors associated with severe hypoglycemia in older adults with type 1 diabetes. Diabetes Care. 2016;39(4):603–10.

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Martyn-Nemeth P, Quinn L, Penckofer S, Park C, Hofer V, Burke L. Fear of hypoglycemia: influence on glycemic variability and self-management behavior in young adults with type 1 diabetes. J Diabetes Complicat. 2017;31(4):735–41.

    PubMed  Article  Google Scholar 

  21. 21.

    King J, Overland J, Fisher M, White K. Severe hypoglycemia and the role of the significant other: expert, sentry, and protector. Diabetes Educ. 2015;41(6):698–705.

    PubMed  Article  Google Scholar 

  22. 22.

    Jull J, Witteman HO, Ferne J, Yoganathan M, Stacey D. Adult-onset type 1 diabetes: a qualitative study of decision-making needs. Can J Diabetes. 2016;40(2):164–9.

    PubMed  Article  Google Scholar 

  23. 23.

    Whittemore R, Jaser S, Chao A, Jang M, Grey M. Psychological experience of parents of children with type 1 diabetes: a systematic mixed-studies review. Diabetes Educ. 2012;38(4):562–79.

    PubMed  Article  PubMed Central  Google Scholar 

  24. 24.

    King PS, Berg CA, Butner J, Butler JM, Wiebe DJ. Longitudinal trajectories of parental involvement in type 1 diabetes and adolescents’ adherence. Health Psychol. 2014;33(5):424–32.

    PubMed  Article  Google Scholar 

  25. 25.

    Joseph NT, Kamarck TW, Muldoon MF, Manuck SB. Daily marital interaction quality and carotid artery intima-medial thickness in healthy middle-aged adults. Psychosom Med. 2014;76(5):347–54.

    PubMed  Article  PubMed Central  Google Scholar 

  26. 26.

    Joensen LE, Almdal TP, Willaing I. Associations between patient characteristics, social relations, diabetes management, quality of life, glycaemic control and emotional burden in type 1 diabetes. Prim Care Diabetes. 2016;10(1):41–50.

    PubMed  Article  Google Scholar 

  27. 27.

    Joensen LE, Almdal TP, Willaing I. Type 1 diabetes and living without a partner: psychological and social aspects, self-management behaviour, and glycaemic control. Diabetes Res Clin Pract. 2013;101(3):278–85.

    PubMed  Article  Google Scholar 

  28. 28.

    Trief PM, Wade MJ, Britton KD, Weinstock RS. A prospective analysis of marital relationship factors and quality of life in diabetes. Diabetes Care. 2002;25(7):1154–8.

    PubMed  Article  Google Scholar 

  29. 29.

    Trief PM, Himes CL, Orendorff R, Weinstock RS. The marital relationship and psychosocial adaptation and glycemic control of individuals with diabetes. Diabetes Care. 2001;24(8):1384–9.

    CAS  PubMed  Article  Google Scholar 

  30. 30.

    Schokker MC, Stuive I, Bouma J, Keers JC, Links TP, Wolffenbuttel BH, et al. Support behavior and relationship satisfaction in couples dealing with diabetes: main and moderating effects. J Fam Psychol. 2010;24(5):578–86.

    PubMed  Article  Google Scholar 

  31. 31.

    Hagedoorn M, Keers JC, Links TP, Bouma J, Ter Maaten JC, Sanderman R. Improving self-management in insulin-treated adults participating in diabetes education. The role of overprotection by the partner. Diabet Med. 2006;23(3):271–7.

    CAS  PubMed  Article  Google Scholar 

  32. 32.

    Trief PM, Jiang Y, Beck R, Huckfeldt PJ, Knight T, Miller KM, et al. Adults with type 1 diabetes: partner relationships and outcomes. J Health Psychol. 2017;22(4):446–56.

    PubMed  Article  Google Scholar 

  33. 33.

    Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546–53.

    PubMed  Article  Google Scholar 

  34. 34.

    CASP Qualitative Checklist. Critical Appraisal Skills Programme. Accessed November 27 2017.

  35. 35.

    Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. National Heart, Lung, and Blood Institute. Accessed November 27 2017.

  36. 36.

    Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15(3):398–405.

    PubMed  Article  Google Scholar 

  37. 37.

    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    PubMed  Article  PubMed Central  Google Scholar 

  38. 38.

    Rajaram SS. Experience of hypoglycemia among insulin dependent diabetics and its impact on the family. Sociology of Health & Illness. 1997;19(3):281–96.

    Article  Google Scholar 

  39. 39.

    Lawton J, Rankin D, Elliott J, Heller SR, Rogers HA, De Zoysa N, et al. Experiences, views, and support needs of family members of people with hypoglycemia unawareness: interview study. Diabetes Care. 2014;37(1):109–15.

    PubMed  Article  Google Scholar 

  40. 40.

    Trief PM, Sandberg JG, Dimmock JA, Forken PJ, Weinstock RS. Personal and relationship challenges of adults with type 1 diabetes: a qualitative focus group study. Diabetes Care. 2013;36(9):2483–8.

    PubMed  Article  PubMed Central  Google Scholar 

  41. 41.

    • Polonsky WH, Fisher L, Hessler D, Johnson N. Emotional distress in the partners of type 1 diabetes adults: worries about hypoglycemia and other key concerns. Diabetes Technol Ther. 2016;18(5):292–7. This study developed and evaluated a diabetes distress scale specific for partners of adults with T1D.

    PubMed  Article  Google Scholar 

  42. 42.

    Morris M, Parker L, Booker S, Johnson A. Partners’ experiences of living with someone with type 1 diabetes. J Diabetes Nursing. 2006;10(5):194–8.

    Google Scholar 

  43. 43.

    Stahl M, Berger W, Schaechinger H, Cox DJ. Spouse’s worries concerning diabetic partner’s possible hypoglycaemia. Diabet Med. 1998;15(7):619–20.<619::AID-DIA616>3.0.CO;2-1.

    CAS  PubMed  Article  Google Scholar 

  44. 44.

    Gonder-Frederick L, Cox D, Kovatchev B, Julian D, Clarke W. The psychosocial impact of severe hypoglycemic episodes on spouses of patients with IDDM. Diabetes Care. 1997;20(10):1543–6.

    CAS  PubMed  Article  Google Scholar 

  45. 45.

    Jørgensen HV, Pedersen-Bjergaard U, Rasmussen ÅK, Borch-Johnsen K. The impact of severe hypoglycemia and impaired awareness of hypoglycemia on relatives of patients with type 1 diabetes. Diabetes Care. 2003;26(4):1106–9.

    PubMed  Article  Google Scholar 

  46. 46.

    Ritholz MD, Beste M, Edwards SS, Beverly EA, Atakov-Castillo A, Wolpert HA. Impact of continuous glucose monitoring on diabetes management and marital relationships of adults with type 1 diabetes and their spouses: a qualitative study. Diabet Med. 2014;31(1):47–54.

    CAS  PubMed  Article  Google Scholar 

  47. 47.

    Barnard K, Crabtree V, Adolfsson P, Davies M, Kerr D, Kraus A, et al. Impact of type 1 diabetes technology on family members/significant others of people with diabetes. J Diabetes Sci Technol. 2016;10(4):824–30.

    PubMed  Article  PubMed Central  Google Scholar 

  48. 48.

    Fisher L, Hessler D, Polonsky W, Strycker L, Masharani U, Peters A. Diabetes distress in adults with type 1 diabetes: prevalence, incidence and change over time. J Diabetes Complicat. 2016;30(6):1123–8.

    PubMed  Article  PubMed Central  Google Scholar 

  49. 49.

    Sullivan-Bolyai S, Deatrick J, Gruppuso P, Tamborlane W, Grey M. Constant vigilance: mothers’ work parenting young children with type 1 diabetes. J Pediatr Nurs. 2003;18(1):21–9.

    CAS  PubMed  Article  Google Scholar 

  50. 50.

    • Young-Hyman D, de Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Psychosocial care for people with diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(12):2126–40. This position statement paper from the ADA provides recommendations for the psychosocial care for PWD (both T1D and T2D) and emphasizes the role of family support in diabetes care.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  51. 51.

    Anderson BJ. Diabetes self-care: lessons from research on the family and broader contexts. Curr Diabetes Rep. 2003;3(2):134–40.

    Article  Google Scholar 

  52. 52.

    Rintala TM, Jaatinen P, Paavilainen E, Astedt-Kurki P. Interrelation between adult persons with diabetes and their family: a systematic review of the literature. J Fam Nurs. 2013;19(1):3–28.

    PubMed  Article  Google Scholar 

  53. 53.

    13. Management of Diabetes in Pregnancy. Diabetes Care. 2017;40(Supplement 1):S114-S9. doi:

  54. 54.

    Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, Bode B, Beck RW, Xing D, Gilliam L, Hirsch I, et al. Sustained benefit of continuous glucose monitoring on A1C, glucose profiles, and hypoglycemia in adults with type 1 diabetes. Diabetes Care. 2009;32(11):2047–9.

    Article  Google Scholar 

  55. 55.

    Rickels MR, Peleckis AJ, Dalton-Bakes C, Naji JR, Ran NA, Nguyen H-L et al. Continuous glucose monitoring for hypoglycemia avoidance and glucose counterregulation in long standing type 1 diabetes.J Clin Endocrinol Metab. 2017:jc.2017–01516-jc.2017-. doi:

  56. 56.

    6. Glycemic Targets. Diabetes Care. 2017;40(Supplement 1):S48-S56. doi:

  57. 57.

    Bailey TS, Grunberger G, Bode BW, Handelsman Y, Hirsch IB, Jovanovič L, et al. American Association of Clinical Endocrinologists and American College of Endocrinology 2016 Outpatient Glucose Monitoring Consensus Statement. Endocr Pract. 2016;22(2):231–61.

    PubMed  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Robin Whittemore.

Ethics declarations

Conflict of Interest

Robin Whittemore, Roberta Delvy, and Margaret M. McCarthy declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Psychosocial Aspects

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Whittemore, R., Delvy, R. & McCarthy, M.M. The Experience of Partners of Adults with Type 1 Diabetes: an Integrative Review. Curr Diab Rep 18, 19 (2018).

Download citation


  • Type 1 diabetes
  • Adults
  • Partners
  • Hypoglycemia
  • Significant others
  • Marriage