A mixed-methods study on social support and diabetes in Ecuador: “Friendship isn’t there anymore”

Abstract Background Type 2 diabetes (T2DM) management requires behaviour modification for optimal glycaemic control, but structural inequalities hinder adherence. Social support (SS) is increasingly perceived as essential in sustaining self-care behaviours, enhancing coping strategies and improving disease awareness among individuals with T2DM. This study explores the role of social support in managing T2DM and its association with glycaemic control (GC) in a low-income community in Quito, Ecuador. Methods Using a mixed methods approach with a parallel convergent design, we gathered quantitative data through structured questionnaires and medical record review in a retrospective cohort of 332 T2DM patients, and assessed sociodemographic characteristics, perceived SS, and GC with logistic regression. Semi-structured interviews with a subsample of 16 individuals offered deeper insights into SS sources and their influence on T2DM management. Results Qualitative analysis identified family support as the most significant source, providing instrumental and emotional support. Participants reported a loss of friendships due to T2DM and the associated changes regarding social events and alcohol consumption or food intake. Other sources of support included health-based support groups. Similarly, in the quantitative analysis, friend support scored lowest, and family support scored highest. Of the 332 patients analysed, 263 (79%) had at least one glucose measurement, and only 28.6% (n = 95) achieved GC. The only subscale of SS that was associated with GC was family support (aOR: 1.07, 95%CI: 1.00-1.14). Conclusions While loss of friends situates family as the main source of support among patients living with T2DM; health-based support groups may also serve as valuable community resources for promoting self-care and GC. Integrating family, friends and community networks into diabetes management strategies is vital for improving health outcomes. Key messages • Strengthening support networks, especially beyond family, is vital for T2DM management by providing emotional, instrumental, and informational aid. • Health-based support groups can be a valuable asset in enhancing social networks and resources for people with T2DM, helping to mitigate the loss of friendships caused by the disease.