For Black men with type 2 diabetes, the quality and content of support networks may be more important than network size

More Americans than ever before are living with type 2 diabetes, and Black men are especially affected. About 13 percent of Black adults in the United States live with the chronic disease, compared to about 8 percent of the general population.

“We know that social support systems impact the management of type 2 diabetes, and we also know that cultural expectations around masculinity, historical experiences of health care and social support dynamics shape how Black men use these networks,” said Tyler Prochnow, PhD, an expert on health behavior and social networks with the Texas A&M University School of Public Health who led the study. “By examining these influences, we can develop more culturally responsive approaches to disease self-management.”

Type 2 diabetes—caused when the body either cannot produce enough insulin or cannot effectively use the insulin it produces—is the most common form of the disease. Prochnow said self-management behaviors such as a healthy diet, exercise and coping skills can help mediate this condition.

“The behavioral challenges are complex for Black men,” said research team member Ledric D. Sherman, PhD. “For example, they often are reluctant to talk about health problems or to seek help because they do not want to appear vulnerable or weak, even though these conversations and support networks are critical for managing chronic diseases like type 2 diabetes.”

Until now, Sherman said, little has been known about how these systems might specifically and uniquely influence Black men with type 2 diabetes.

“Type 2 diabetes is not a ‘single person’s disease,’ but affects family members and others in the person’s social environment,” he said. “We wanted to examine how the different characteristics of the social support networks of Black men with type 2 diabetes influence their self-management of the disease.”

Survey focuses on social network makeup and influence

For their study, funded by a grant from the National Institute on Minority Health and Health Disparities and published in Preventive Medicine, the researchers conducted a survey from February to June 2024 of 1,225 Black men with type 2 diabetes in the United States.

Participants listed the people they confided in, the ones who gave them advice and practical support and who made managing their type 2 diabetes difficult. They also indicated whether these individuals also had type 2 diabetes. The average participant’s social network had six people. Friends were the most common types of members (18.8 percent), followed by health care providers (17.7 percent) and parents (15.1 percent). About 18.6 percent also had type 2 diabetes.

Participants then indicated how often they communicated with members of their networks, the quality of the support they received and how they perceived the health behaviors of those in their networks.

Self-care activities were measured using the Summary of Diabetes Self-Care Activities scale for diet, physical activity, blood sugar testing and foot care.

Findings reflect previous work while adding new contributions

“Our findings build on those of previous research by revealing that having diabetes-focused discussions and very supportive individuals is what makes the real difference in day-to-day care,” said researcher Megan S. Patterson, PhD.

More specifically, the study found that very supportive network members positively influence diet and physical activity and that different relationship types support different aspects of diabetes self-management.

The analysis revealed three other noteworthy findings. First, having a few highly supportive members in the social support network was positively associated with self-care activities, while getting general support from across the broader network had negative associations, suggesting the importance of relationships with key members of the network rather than expanding the overall network.

Second, having health care providers in one’s network was not associated with self-care behaviors, likely reflecting the challenges many Black men face in health care interactions and aligning with previous research on social isolation and health care disparities.

“The fact that having health care providers in one’s network didn’t improve self-care behaviors presents an interesting paradox,” said Matthew Lee Smith, PhD. “This might indicate that men who rely heavily on health care providers for support may have fewer informal support resources, or conversely, that those struggling most with diabetes management seek more professional help.”

Either way, he said, this highlights the importance of developing a better understanding of the health care relationship in the context of Black men’s broader social support systems and to bridge formal medical care with the cultural and interpersonal dynamics that influence day-to-day diabetes management.

Finally, the analysis revealed an important distinction in how social norms within networks influenced different health behaviors. For example, participants who reported that their network members engaged in healthy eating showed significant positive associations with diet but not with physical activity.

Bottom line: Social network quality is more important than quantity for Black men with type 2 diabetes

Prochnow said the study suggests that programs should focus on fostering quality, disease-specific support rather than simply expanding social networks.

“For Black men managing type 2 diabetes, interventions should create safe spaces for vulnerability and disease-specific communication within trusted relationships,” Prochnow said.

Open conversations about diabetes management with children, friends or spouses can create positive social accountability and reinforcement that respects cultural values while supporting health goals, which often lead to better self-care behaviors, he said.

“It’s about strengthening the connections that already exist in ways that make diabetes management a shared priority rather than a solitary burden,” Prochnow said.