Links Between Social Isolation, Type 2 Diabetes Show Need for Friendships

The mantra of “diet and exercise” sounds so simple when it comes to preventing type 2 diabetes (T2D). But for some, just connecting with others is a challenge, and that makes the rest of healthy living more difficult.

Now, researchers publishing in BMC Public Health have measured the link between a person’s social connections and the likelihood of developing T2D, and they find there’s enough evidence that being isolated should be a red flag for health systems to step in.

The good news? Social support, from both peers and coaches, is a key element of a diabetes prevention strategy, and will be a feature of Medicare Diabetes Prevention Program (DPP) that is set to launch April 1, 2018. It’s the first preventive service that CMS will fund.

And at least one US payer has been targeting loneliness among seniors as a strategy to prevent chronic disease and other ailments. CareMore Health, a division of Anthem, appointed Chief Togetherness Officer Robin Caruso, LCSW, earlier this year, after reporting that 43% of seniors were affected by loneliness. A 2016 study linked a person’s number of friendship with measures of belly fat, inflammation, and high blood pressure.

The researchers asked questions of 2861 people taking part in the Maastricht study, a large population health cohort study in the Netherlands (members are age 40 to 75). For this project, the team measured several aspects of a person’s personal network—how many people it included, how frequently they interacted with people, and the types of relationships (friends, family, or acquaintances) they had. They also asked whether the participants lived alone, and how much social or practical support they had.

Using questionnaires, the researchers probed the quality of the participants’ networks and support systems and whether their characteristics were associated with prediabetes, newly diagnosed T2D, or previously diagnosed T2D. For example, questions asked the participants who they turned to for help with a problem, or who they went out with for an evening.

Both women and men were affected by isolation, but in slightly different ways. For both, those with diabetes tended to have smaller networks: among women with T2D, the average network size was 8, compared to 12 for those without T2D; for men, the average network size was 7 for those with T2D and 10 for those without.

Among women with T2D, network members were more likely to live nearby and be family members rather than friends.

The results show a direct relationship between network size and the likelihood of developing diabetes: each fewer network member reported was associated with 12% higher odds of newly diagnosed T2D and 8% higher odds of previously diagnosed T2D in women, and 10% higher odds of newly diagnosed and 5% higher odds of previously diagnosed T2D in men, respectively, compared with normal glucose status.

Proximity counts. Having friends and having them close matters for women. Each 10% drop in network members living within walking distance was associated with a 21% higher odds of newly diagnosed T2D among women, as well as a 9% higher odds of previously diagnosed T2D.

Friends versus family. Every additional 10% a woman’s network made up of household members was associated with a 25% higher odds of newly diagnosed T2D and 15% higher odds of previously diagnosed T2D. For men, each additional 10% of the network made up of household members led to a 29% increase in newly diagnosed T2D. And, for women, each 10% drop in network members who were friends was linked to a 14% higher odds of previously diagnosed T2D.

Being involved matters, writes Stephanie Brinkhues, the lead author and a PhD candidate at Maastricht University. Both men and women who perceived less social support were more likely to have T2D—men who lived alone were at particularly high risk. Volunteering and joining a club should be encouraged, she said.

Need for intervention. Brinkhues wrote in a blog post that encouraging more social integration “may prove a promising prevention strategy.”

“Socially isolated individuals could be encouraged to improve their lifestyle, for instance lose weight and become more physically active, in a setting that increases their social integration,” she writes. “Such interventions should enable extension and broadening of the social network, by supporting them to make new friends.”

Brinkhues writes that many studies are pointing out the connection between isolation and poor health, even infectious disease.

“Although the mechanisms underlying the associations of social network characteristics with the development of type 2 diabetes are not yet elucidated, our findings are of great importance to the field of diabetes prevention,” she writes. “Our results implicate that strengthening of the social network can be used to optimize non-medical prevention strategies for type 2 diabetes. Our findings support the idea that solving social isolation may prevent the development of type 2 diabetes.”

Reference

Brinkhues S, Dukers-Muijrers NHTM, Hoebe CJPA, et al.Socially isolated individuals are more prone to have newly diagnosed and prevalent type 2 diabetes mellitus—the Maastricht study [pubished online December 19, 2017]. BMC Pub Health. 2017. doi:10.1186/s12889-017-4948-6.