Social Relationships and Risk of Type 2 Diabetes Among Postmenopausal Women

Abstract

Objectives We examined whether social relationship variables (social support, social strain, social network size, and stressful life events) were associated with risk of developing type 2 diabetes among postmenopausal women. Method 139,924 postmenopausal women aged 50–79 years without prevalent diabetes at baseline were followed for a mean of 14 years. 19,240 women developed diabetes. Multivariable Cox proportional hazard models tested associations between social relationship variables and diabetes incidence after consideration of demographics, depressive symptoms, and lifestyle behaviors. We also examined moderating effects of obesity and race/ethnicity, and we tested whether social variable associations were mediated by lifestyle or depressive symptoms. Results Compared with the lowest quartile, women in the highest social support quartile had lower risk of diabetes after adjusting for demographic factors, health behaviors, and depressive symptoms (hazard ratio [HR] = 0.93, 95% confidence interval [CI] = 0.89–0.97). Social strain (HR = 1.09, 95% CI = 1.04–1.13) and stressful life events (HR = 1.10, 95% CI = 1.05–1.15) were associated with higher diabetes risks. The association between diabetes and social strain was stronger among African American women. Social relationship variables had direct relationships to diabetes, as well as indirect effects partially mediated by lifestyle and depressive symptoms. Discussion Social support, social strain, and stressful life events were associated with diabetes risk among postmenopausal women independently of demographic factors and health behaviors. In addition to healthy behaviors such as diet and physical activity, healthy social relationships among older women may be important in the prevention of diabetes.

Loneliness and type 2 diabetes incidence: findings from the English Longitudinal Study of Ageing

“…Social isolation or living alone were not independent risk factors for type 2 diabetes onset in this study. This result is in keeping with the majority of previous studies, which have also failed to observe an association between social isolation [15,16,18,19] or living alone [17,21,22] and type 2 diabetes incidence when taking sociodemographic factors, health behaviours and clinical characteristics into account. Our findings are in contrast with analyses from the MONICA/KORA Augsburg cohort, where prospective associations of social isolation [18] and living alone [20] with incident diabetes were observed in male participants.…”

“…To date, no study has prospectively associated loneliness with incident type 2 diabetes, although there is evidence of a crosssectional association [13,14]. Some studies have investigated social isolation [15][16][17][18][19] or living alone [17,[20][21][22] as risk factors for type 2 diabetes. However, it is important to note that loneliness is not synonymous with social isolation as it relates to the perceived quality rather than quantity of social connections [1].…”

“…The majority of studies assessing social isolation [15,16,18,19] and living alone [17,21,22] as risk factors for diabetes have failed to observe an association when taking potential confounding factors (such as health behaviours) into account. The German MONICA/KORA (MONitoring of Trends and Determinants in CArdiovascular Disease/Kooperative Gesundheitsforschung in der Region Augsburg (Cooperative Health Research in the Region of Augsburg) cohort of over 8000 participants found prospective associations between social isolation [18] and living alone [20] with incident diabetes, but only in male participants.…”

Social support, strain, and glycemic control: A path analysis

“…However, there is increasing evidence for an association between social factors and T2D risk. For instance, in examining social relationship variables and T2D risk among postmenopausal women, Hendryx et al (2019) found that women who had the highest levels of social support had a lower risk of developing T2D. Likewise, in a population‐based study in Sweden, Norberg et al (2007) found that low emotional support may contribute to T2D risk in women.…”

“…This is also reflected in findings from a study of postmenopausal women. Specifically, social strain was associated with an increased risk of developing T2D (Hendryx et al, 2019). Finally, a review of social determinants of T2D showed links with stress, unmet personal needs due to attention to spousal needs, and the potential difficulty of managing self‐care within social networks (Clark & Utz, 2014).…”