Spousal diabetes status linked to elevated risk of type 2 diabetes
Individuals who have a spouse with diabetes are at increased risk of developing type 2 diabetes themselves, with the effect of spousal diabetes status going beyond the effect of other risk factors, according to a study.
In the study, the investigators drew data from the ARIC cohort and conducted a prospective analysis of 8,077 married men and women (mean age, 54 years) who were free of diabetes at baseline. They also conducted a meta-analysis of studies that evaluated spousal concordance for diabetes.
A total of 2,512 incident diabetes cases occurred over a median follow-up of 22 years. Most of the cases (n=2,239) were defined based on blood glucose levels or medication, while 668 were based on blood glucose levels alone. [Acta Diabetol 2019;56:619-629]
Individuals with a spouse diagnosed with diabetes were more likely to develop diabetes than those whose spouse did not have the condition at baseline (hazard ratio [HR], 1.48, 95 percent CI, 1.30–1.67). This risk was slightly greater among husbands whose wife had diabetes (HR, 1.63, 1.36–1.96) than among wives whose husband had diabetes (HR, 1.44, 1.21–1.71), although the difference was not statistically significant (p=0.62).
On further analysis, which was controlled for general adiposity, spousal cardiometabolic factors and other diabetes risk factors, the risk of incident diabetes remained elevated in individuals who had a spouse with vs without diabetes (HR, 1.20, 1.02–1.41). This association persisted in subgroups defined by sex and race.
Pooled data from 17 studies (489,798 participants from nine countries) likewise showed a positive association between spousal diabetes status and incident diabetes (pooled odds ratio, 1.88, 1.52–2.33).
According to the investigators, the shared diabetes risk among married couples or partners observed in the present and other studies may be attributed largely to shared behaviour/lifestyle and environmental factors.
“Two theories have been widely publicised to explain the influence of behaviour/lifestyle factors on shared diabetes risk among spouses. The first theory…refers to the tendency of individuals to select spouses based on preference for similar phenotypic characteristics and normative attribute such as health norms, body composition, physical, or sedentary activities and socioeconomic status,” they pointed out. [Diabetologia 2018;doi:10.1007/s00125-018-4587-1; Prev Med 2017;105:52-57]
“The second theory alludes to spouses converging in their behaviours and lifestyle over the course of the marriage as a result of engaging in similar activities, practices and habits,” they added. [Diabetologia 2018;61:1517-1521]
Taken together, the present data are said to have important clinical and public health implications, in light of the rapidly increasing worldwide diabetes prevalence and the 174.8 million diabetes cases in adults that are estimated to be undiagnosed. [Diabetes Res Clin Pract 2014;103:150-160]
“Spousal concordance or history of spousal diabetes status can be leveraged to bolster efforts to identify high risk individuals or undiagnosed diabetes cases for couple-based lifestyle preventive services, counselling or care-delivery interventions,” the authors said.
“Such interventions have been shown to yield clinically significant results even when only one spouse receives the intervention. For example, having a spouse, relative or friend with diabetes is known to elicit lifestyle changes towards good health and in some instances motivate individuals without diabetes to seek screening and preventive care,” they continued. “Thus, if one spouse adapts healthy lifestyle behaviours, the other spouse is usually more likely to do so as well.”[Health Serv Res 2008;43:96-116.61; Ann Fam Med 2018 16:290-295].