Researchers discover link between loneliness and diabetes risk

Loneliness, according to study, is related with a significantly higher risk of developing type 2 diabetes (T2D).

Associate Professor Roger E. Henriksen and his colleagues at Western Norway University of Applied Sciences performed the study, which was published in Diabetologia (the magazine of the European Association for the Study of Diabetes [EASD]). It investigated whether sadness and sleeplessness have a role in the connection between loneliness and the likelihood of developing T2D. A increasing amount of data suggests a relationship between psychological stress and the likelihood of acquiring T2D. Loneliness induces a persistent and, in certain cases, long-term state of discomfort, which may trigger the body’s physiological stress response.

While the precise processes are unknown, this reaction is thought to play a key part in the development of T2D via mechanisms such as transient insulin resistance caused by high levels of the stress hormone cortisol.

This process also includes alterations in the brain’s regulation of eating behaviour, resulting in an increased hunger for carbs and, as a result, raised blood sugar levels. Previous research has established a link between loneliness and unhealthy eating, such as increased consumption of sugary drinks and meals high in sugar and fat.

While the precise processes are unknown, this reaction is thought to play a key part in the development of T2D via mechanisms such as transient insulin resistance caused by high levels of the stress hormone cortisol.

This process also includes alterations in the brain’s regulation of eating behaviour, resulting in an increased hunger for carbs and, as a result, raised blood sugar levels. Previous research has established a link between loneliness and unhealthy eating, such as increased consumption of sugary drinks and meals high in sugar and fat.

The key outcome variable was T2D status, which was based on HbA1c (glycated haemoglobin – a kind of haemoglobin).

T2D status was the primary end variable, with HbA1c (glycated haemoglobin – a marker of long-term blood sugar management) more than 48mmol/mol as evaluated in the HUNT4 survey.

Loneliness was measured on a four-point scale (‘no,’ ‘a little,’ ‘a decent bit,’ and’very much’) using data from the HUNT2 survey.

The intensity of depressive symptoms was examined using a questionnaire completed during HUNT3, which comprised of 7 items, each scored on a scale of 0-3 for a total of 0-21 points, with higher scores indicating more severe symptoms.

Individuals with insomnia were identified based on their responses to the following questions: ‘How frequently in the previous 3 months have you: ‘had trouble falling asleep at night’, ‘woken up repeatedly during the night’, and ‘woken too early and couldn’t get back to sleep?’ As part of HUNT3, participants were asked to pick one of three answers: ‘never/seldom,”sometimes,’ or’several times a week.’

Over the course of the trial, 1,179 (4.9%) of the 24,024 participants had T2D. (1995-2019). These people were more likely to be men (59% vs 44%) and had a higher mean age (48 years vs 43 years) than those who did not have T2D.

They were also more likely to be married (73% vs. 68%) and to have the lowest degree of education (35 per cent vs 23 per cent). One-third of those polled expressed feelings of loneliness.

The study discovered that higher degrees of loneliness at the start were highly connected with a higher risk of T2D 20 years later. After controlling for age, gender, and education level, they discovered that individuals who answered’very much’ when asked whether they had felt lonely were twice as likely to acquire T2D as those who did not.

Further investigation revealed that the presence of depression, sleep-onset insomnia, or terminal insomnia had no effect on this association, however the team did discover evidence of a correlation to sleep maintenance insomnia.

Although the researchers did not investigate the specific processes involved, they do remark that social support, influence, and involvement may have a good impact on health-promoting behaviours. Advice and encouragement from a friend, for example, may impact an individual’s health-related decisions and favourably effect their nutrition, physical activity level, and overall stress levels. Lonely persons may be more sensitive to behaviour that increases their chance of having T2D if they have less social relationships and a lack of these beneficial impacts.

The researchers recommend that loneliness be included in T2D clinical recommendations. “It is critical that healthcare practitioners are open to discourse about an individual’s issues during clinical consultations, including loneliness and social engagement,” they write.

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The authors advocate for more study into the processes behind the association between loneliness and T2D, as well as the involvement of insomnia and depression. “Questions to be answered include the amount to which loneliness activates stress responses, the extent to which loneliness influences health-related behaviour, and, significantly, how these two pathways combine in terms of contributing to an elevated risk of T2D,” they conclude.

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