This work was carried out in and around Mangalore city in Karnataka state, where we could find rapid urbanization. Case-control study design was adopted. Total sample size of subjects was 500, which included 250 Type 2 Diabetes Mellitus subjects, as per the WHO criteria and 250 Non-Diabetics. Patients were chosen randomly for both case and control studies and they belonged to different economic classes. Subjects were selected from in and around Dakshina Kannada District, India. Questionnaires were given to patients who were graduates and above, for their self assessments. Researchers personally assisted those who were illiterate and who needed assistance in understanding the questionnaire. Total time taken for filling up the questionnaire was 45min. Age—sex—religion—matching data were obtained. Patients’ consent were taken. Ethical clearance was taken for conducting the study. Perceived stress scale and Family assessment Device were used to collect the data.

For obtained parameters, analysis was done by using the unpaired t-test, Chi-Square and Pearson’s Correlation co-efficient test and a p-value of <0.05 was considered to be significant.

Our study included 500 subjects who consisted of 250 Diabetics and 250 Non-Diabetics. [Table/Fig-1] shows the demographic profile of the study population. Among the various occupations, group prevalence of diabetes was found to be high among business category (36.0%), followed by that which was seen among housewives (20.40%). Prevalence of Diabetes was found to be high among subjects with graduate qualification (34.0%) as compared to that which was seen among those with any other level of education. It also showed that most of the Diabetics were married, which was indicated by the score of 93.6% and among Non-Diabetics, 90.4% were married. This difference was statistically significant. The prevalence of Diabetes among widows and singletons was found to be not statistically significant. Among the Diabetics, only 42% were found to have a family history of Diabetes and among Non-Diabetics, 94.4% did not have any association with family history, which was found to be statistically significant. Regular consumption of medication was found to be high among the Diabetics, which was indicated by the score of 68.4%. The difference was found to be statistically significant. Menopausal status was found to be significant among diabetics. The prevalence was high among people who had regular menopause as compared to those who were in other stages of menopause, which was indicated by the p-value of <0.001.

Results showed a significant relationship between stress scores among Diabetics and Non-Diabetics, which was indicated by a p-value of <0.001 [Table/Fig-2].

The scores in [Table/Fig-3] indicates that among the different domains of family functioning, in the area of Problem solving Diabetics have better skills than Non-Diabetics. In the remaining areas like Communication, Affective Responsiveness, Affective Involvement and Behavioral Involvement, no significant relationship is seen.

[Table/Fig-4] state that all the domains of Family Assessment Devices, like General Functioning, Problem Solving, Communication, Affective Involvement, Affective Responsiveness, Behaviour Control were positively associated with Perceived Stress Scale (p<0.001). Except, Family Roles which involved current and changing roles and patterns of behaviour that facilitated family functioning, which is negatively associated with Perceived Stress Score.

The present study revealed that Perceived Stress was found to be high among Diabetic subjects than among Non-Diabetics (p<0.001). Study conducted by Takihiro et al., supported the present study results and it proved the relationship between psycho-social factors and the glycaemic control of patients with Type 2 Diabetes [3]. In the present study, a significant association was found between Diabetes and Family history. Erasmus R et al., conducted a study on black African-Americans, which supported the data of a positive family history. [4] Diabetes was found to be more among urban population than rural population, which could be compared with the findings of the study which was conducted by Rayappa P et al., [5]. In the present study, it was found, that a majority of diabetic study population was females, but a study which was conducted by Siddartha et al., contradicted the findings of the present study, where a majority of the subjects were males [6]. From the present study, it was found that stress influenced the glycaemic levels of Diabetics. A similar study which was conducted by Riazi et al., supported our study by indicating that stress influenced glycaemic levels in different ways in diabetics [7]. Stress directly affects the blood glucose level by influencing the neuroendocrine systems [8,9]. Family played a vital role in lives of individuals. In our study, it was found that in different domains of family functioning, Non-Diabetics had found their families to be more supportive than Diabetics, in Family Roles, General Functioning and Problem Solving. A similar study done by Adetunji A et al., proved the same, when they found individual correlate positively with their blood glucose found that their families were supportive as compared to those who did not have family support. The present study indicated that stress and family support were positively correlated. As diabetes is a highly self-managed disease, stress along with lack of social and family support, can have a significant impact on self-management and outcome [10–13]. Our study showed that in the domains of family Problem Solving and Family Roles, mean score in Non-Diabetics was statistically significant as compared to that in Diabetics. This was supported by a similar study done, which showed that spousal support helped in dealing with condition of patients in a better way [14]. Communication domain of family functioning did not show any statistical significance, whereas a study done by David L et al., contradicted this by proving that communicating the risks of Diabetes to family members improved the management of Diabetes [15]. Results stated that all the domains of Family Assessment Devices, like general functioning, problem solving, communication, affective involvement, affective responsiveness, behaviour control were positively associated with Perceived Stress Scale (p<0.001). However, Family Roles showed a negative correlation with stress levels. This could be due to current or changing roles and patterns of behaviour that had facilitated family functioning especially, those that met basic needs, that designated responsibilities for household tasks were found to be very demanding and they increased the stress levels. A similar study done by Pierce M et al., [16] supported our finding that the process of diabetes management could be so demanding, that the subject could experience anger, frustration and discouragement without family support. A Diabetes-related conflict may occur in course of time with loved ones and relationships with health care providers may become strained. The risk of depression can be high [17].

Our present study reported that Perceived Stress was an important aspect which had to be taken care of in the management of Type 2 Diabetes Mellitus, because it affected the glycaemic levels of Type 2 diabetic individuals. Family plays a valuable role in an individual’s life and stress does influence the family functioning of subjects. Involving family members as a part of Diabetes Management plays a major role. Positive interpersonal relationships help in managing diabetes in a better way. Stress management technique should be included in diabetes education programme.

A psychosocial approach will help in designing a psycho-social model which will provide the clinicians an insight into consistent, practical approaches for assessing and treating Diabetic individuals, and their families, which include psychological and social dimensions. The total sample size was a limitation in our study, but as few correlational studies have been done on stress and family functioning in Type 2 Diabetes, this study provided the preliminary data for further studies.