In Sickness and in Health: Spouses Have Double Diabetes Risk

June 06, 2015

BOSTON — Spouses or live-in partners of people newly diagnosed with diabetes were twice as likely to develop diabetes themselves — compared with people in the general population — in the year following the initial diagnosis of their loved one, new data from a large Kaiser Permanente study show.

"We know that health-related risks tend to occur among people who are socially connected," explained Dr Mohammed K Ali of Emory University, Atlanta, Georgia, who reported the findings here at the American Diabetes Association (ADA) 2015 Scientific Sessions today. "We wanted to specifically examine whether cohabiting partners of people newly diagnosed with diabetes had elevated risks of developing diabetes themselves."

The findings, he says, "are quite striking. Not only are they provocative, but the implications are huge. It might be important to think about talking to the spouses or partners [of newly diagnosed patients] about their own risks.

"Even if you are not genetically related, if you are a residing spouse or domestic partner, just that shared environment is associated with an increased risk, that's what we saw," Dr Ali told Medscape Medical News.

"The take-home message is that it might push us a bit more to say, if someone is newly diagnosed, what's happening with their partner? And instead of waiting for years and years for that partner to show up for their own glucose test, maybe we should preempt it.

"It may not be going as far as doing a glucose test, it might just be weighing them, or doing a 'paper-pencil' test — asking them a few questions about age, weight, etc. That might be the most prudent way, but it certainly seems necessary."

Asked her thoughts on the study, session chair Audrey C Chu, PhD, from Brigham and Women's Hospital, Boston, Massachusetts, said: "We've found a lot of genetics that are predictive of type 2 diabetes, but this is showing how strong an environmental effect [can be], and this is an important area for new interventions to focus on in the future."

And Dr Bendix Carstensen, from the Steno Diabetes Center, Gentofte, Denmark, said this was the first time he had come across such an association. "It's interesting to me. This [kind of analysis] could easily be done in Scandinavian countries too, because we only have one health-maintenance organization in each country," he told Medscape Medical News.

But James B Meigs (Massachusetts General Hospital, Boston) said he fears this study suffers from failure to account for one major confounding factor. "The researchers didn't account for body mass index, and I believe that if you accounted for obesity, a lot of the effect would go away."

He said he is concerned that "they are making big prevention pronouncements with data that might be wrong. If you get the data right, you might come to a different answer that still has prevention implications."

Can We Add "With Whom You Live" as Another Risk Factor?

Dr Ali explained that there are almost 30 million people living with diabetes in the United States and 86 million with prediabetes. But awareness of glycemic status and perceived risk are low — 89% of people with prediabetes are unaware of their status, for example, and one in four of those with type 2 diabetes are also undiagnosed.

The American Diabetes Association recommends a glucose test for anyone over the age of 45 years or at any age if body mass index is 25 kg/mg2 or higher (23 kg/mg2 or higher in Asian Americans) and there are one or more risk factors for diabetes.

The latter include a first-degree relative with diabetes, physical inactivity, high blood pressure or dyslipidemia, or a history of gestational diabetes or polycystic ovary syndrome for women, among other things.

"But could there be other antecedent factors that predispose to diabetes risk factors? Like whom you live with?" Dr Ali suggested. "If you're not genetically related, how might your risk increase?" he wondered.

To examine this, he and his colleagues analyzed 2005 to 2011 data from Kaiser Permanente Northern California covering more than 3 million members.

They estimated the average annual incidence of diabetes among those aged 18 to 79; whether it was type 1 or 2 diabetes wasn't specified, he noted, but most newly diagnosed diabetes among adults would be type 2, he said.

They also estimated annual diabetes incidence rates among the spouses and cohabiting domestic partners of members diagnosed with diabetes in the previous year and finally compared both of these figures with those obtained from the general US population.

Incident diabetes was defined as two or more outpatient diagnoses, or one or more inpatient or emergency-room diagnosis, or being on diabetes medications, except metformin alone, in the past two years.

Incidence of Diabetes Doubled Among Spouses of Newly Diagnosed

The diabetes incidence among Kaiser Permanente members was similar to that reported in the general US population (according to Centers for Disease and Prevention figures).

But the incidence was much higher among spouses of people newly diagnosed with diabetes compared with Kaiser Permanente's overall population — indeed, double, when all ages were combined (1.71% vs 0.83%).

Women with newly diagnosed spouses had 90% higher risks than women in the overall Kaiser Permanente population (1.35% vs 0.71%) and for men who were spouses of those newly diagnosed, the risk was even higher, almost 2.5 fold, at 2.22% vs 0.96%.

There was no difference across different racial groups. In fact, "there was a very distinct pattern of doubling [of diabetes risk in spouses of those newly diagnosed with diabetes] across all ethnic groups," Dr Ali observed.

There were a number of same-sex partners in the analysis, but the numbers are too small so far to draw meaningful conclusions on this demographic group, he noted.

Dr Ali acknowledged that these are observational data and that there may be an effect whereby spouses of those newly diagnosed were encouraged to seek a glucose test themselves following their partner's diagnosis, thereby explaining some of the increased risk.

The next analysis they will perform will take this into consideration, he said.

Dr Ali and Dr Chu reported no relevant financial relationships.

American Diabetes Association 2015 Scientific Sessions; June 6, 2015; Boston, Massachusetts. Abstract 77-OR

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