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

ABSTRACT: AIMS/HYPOTHESIS:Loneliness is associated with all-cause mortality and coronary heart disease. However, the prospective relationship between loneliness and type 2 diabetes onset is unclear. METHODS:We conducted a longitudinal observational population study with data on 4112 diabetes-free participants (mean age 65.02?±?9.05) from the English Longitudinal Study of Ageing. Loneliness was assessed in 2004-2005 using the revised University of California, Los Angeles (UCLA) Loneliness Scale. Incident type 2 diabetes cases were assessed from 2006 to 2017. Associations were modelled using Cox proportional hazards regression, adjusting for potential confounders, which included cardiometabolic comorbidities. RESULTS:A total of 264 (6.42%) participants developed type 2 diabetes over the follow-up period. Loneliness was a significant predictor of incident type 2 diabetes (HR 1.46; 95% CI 1.15, 1.84; p?=?0.002) independent of age, sex, ethnicity, wealth, smoking status, physical activity, alcohol consumption, BMI, HbA1c, hypertension and cardiovascular disease. Further analyses detected an association between loneliness and type 2 diabetes onset (HR 1.41; 95% CI 1.04, 1.90; p?=?0.027), independent of depressive symptoms, living alone and social isolation. Living alone and social isolation were not significantly associated with type 2 diabetes onset. CONCLUSIONS/INTERPRETATION:Loneliness is a risk factor for type 2 diabetes. The mechanisms underlying this relationship remain to be elucidated. Graphical abstract.

SUBMITTER: Hackett RA

PROVIDER: S-EPMC7527325 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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

Hackett Ruth A RA Hudson Joanna L JL Chilcot Joseph J

Diabetologia 20200915 11

<h4>Aims/hypothesis</h4>Loneliness is associated with all-cause mortality and coronary heart disease. However, the prospective relationship between loneliness and type 2 diabetes onset is unclear.<h4>Methods</h4>We conducted a longitudinal observational population study with data on 4112 diabetes-free participants (mean age 65.02 ± 9.05) from the English Longitudinal Study of Ageing. Loneliness was assessed in 2004-2005 using the revised University of California, Los Angeles (UCLA) Loneliness Sc ...[more]

PMID: 32929525

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Project description:AIMS/HYPOTHESIS:The aim of the study was to evaluate longitudinal associations between HbA1c levels, diabetes status and subsequent cognitive decline over a 10 year follow-up period. METHODS:Data from wave 2 (2004-2005) to wave 7 (2014-2015) of the English Longitudinal Study of Ageing (ELSA) were analysed. Cognitive function was assessed at baseline (wave 2) and reassessed every 2 years at waves 3-7. Linear mixed models were used to evaluate longitudinal associations. RESULTS:The study comprised 5189 participants (55.1% women, mean age 65.6 ± 9.4 years) with baseline HbA1c levels ranging from 15.9 to 126.3 mmol/mol (3.6-13.7%). The mean follow-up duration was 8.1 ± 2.8 years and the mean number of cognitive assessments was 4.9 ± 1.5. A 1 mmol/mol increment in HbA1c was significantly associated with an increased rate of decline in global cognitive z scores (-0.0009 SD/year, 95% CI -0.0014, -0.0003), memory z scores (-0.0005 SD/year, 95% CI -0.0009, -0.0001) and executive function z scores (-0.0008 SD/year, 95% CI -0.0013, -0.0004) after adjustment for baseline age, sex, total cholesterol, HDL-cholesterol, triacylglycerol, high-sensitivity C-reactive protein, BMI, education, marital status, depressive symptoms, current smoking, alcohol consumption, hypertension, CHD, stroke, chronic lung disease and cancer. Compared with participants with normoglycaemia, the multivariable-adjusted rate of global cognitive decline associated with prediabetes and diabetes was increased by -0.012 SD/year (95% CI -0.022, -0.002) and -0.031 SD/year (95% CI -0.046, -0.015), respectively (p for trend <0.001). Similarly, memory, executive function and orientation z scores showed an increased rate of cognitive decline with diabetes. CONCLUSIONS/INTERPRETATION:Significant longitudinal associations between HbA1c levels, diabetes status and long-term cognitive decline were observed in this study. Future studies are required to determine the effects of maintaining optimal glucose control on the rate of cognitive decline in people with diabetes.

Project description:BACKGROUND:As the population ages, cognitive decline and dementia have become major health concerns in the UK. Loneliness has been linked to cognitive decline, but the reverse causality of this association remains unclear. This study aims to examine whether there is a bidirectional relationship between loneliness and cognitive function in older English adults (age 50?years and over) over a 10-year follow-up. METHODS:Data came from a nationally representative sample of 5885 participants in the English Longitudinal Study of Ageing (ELSA), free of stroke or dementia and followed every 2 years up to wave 7 (2014-15). At each wave, cognitive function was measured with word recall and verbal fluency tests, and loneliness was measured with the abridged version of the revised UCLA Loneliness Scale. Bivariate dual change score models were used to assess the multivariate associations between loneliness and cognitive function, used interchangeably as exposures and outcomes. RESULTS:Greater loneliness at baseline was associated with poorer memory [? intercept = -0.03, standard error (SE) = 0.01, P? = ?0.016] and verbal fluency (? intercept = -0.01, SE? = ?001, P = ?0.027) at baseline, and with a stronger linear rate of decline in both memory (? linear slope = -0.07, SE? = ?001, P ???0.001) and verbal fluency (? linear slope = -0.09, SE? = ?0.03, P = ?0.003) over a 10-year follow-up period, although the performance on verbal fluency did not change substantially on average over this period. We also found that higher baseline memory, but not verbal fluency, predicted a slower change in loneliness (? linear slope = -0.01, SE? = ?001, P = ?0.004) and that a linear decline in memory was associated with an acceleration in loneliness (? quadratic slope = -0.02, SE? = ?001, P ???0.001) during follow-up. CONCLUSIONS:Higher loneliness is associated with poorer cognitive function at baseline and contributes to a worsening in memory and verbal fluency over a decade. These factors seem, however, to be partially intertwined, since baseline memory and its rate of decline also contribute to an increase in loneliness over time.

Dataset Information

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

Publications

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

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