Marlene Busko

September 11, 2017

LISBON, PORTUGAL — Husbands in their late 50s and 60s were more likely to develop type 2 diabetes if their wives were overweight or obese, but this was not true for wives with heavier husbands, reveals a new study based on couples in the English Longitudinal Study of Aging (ELSA).

In addition, these older men and women who had spouses with type 2 diabetes were more likely to be heavier than their peers whose spouses did not have diabetes, researchers report, in a second, related study.

"It doesn't mean that the wife's [body mass index] BMI is the most determinant" factor for a husband's obesity, Dr Adam Hulman, from Aarhus University, Denmark, cautioned the press here at the European Association for the Study of Diabetes (EASD) 2017 Annual Meeting. The man's "own BMI is still the most important factor," he stressed.

"One explanation could be that at the end of the 1990s in the UK, women were more responsible for or the ones who determined the diet of the family or the household," he suggested

The implications for clinicians are, that to assess type 2 diabetes risk, "there is the regular question — whether your parents or a sibling have diabetes — and this study calls attention that there are [also] other connections within the family" that could play a role.

Thus, "If you find that the spouse has obesity, pay attention on the other half of the couple."

Senior author for both studies, Daniel R Witte, MD, PhD, from Aarhus University reiterated this message, speaking to Medscape Medical News. "In the current very individualized way of approaching diabetes risk we sometimes forget [the patient's social network], and I think this is a reminder that we should pay close attention to the home environment."

There is a need to "approach the person as part of a family unit rather than as an individual."

Spousal Obesity and Risk of Diabetes

It's well known that physical inactivity, an unhealthy diet, obesity, and family history are major risk factors for type 2 diabetes, but less is known about how men and women in a couple may share diet and physical-activity behaviors that may affect their risk of diabetes, Dr Hulman said.

To examine this, they identified about 7000 men and women who were couples living in the same household and who were part of ELSA, a representative cohort of the English population aged >50 years, from 1998 to 2015.

This sample excluded same-sex partners but included couples who were not married.

On average, at study entry the participants were 60 years old and overweight, with a BMI of 27 kg/m2.

At baseline, 6% of the husbands and 4% of the wives had diabetes.

The participants replied to questionnaires and had blood tests every 2.5 years, and new-onset diabetes was defined based on self-report or fasting plasma glucose > 7 mmol/L or HbA1c >6.5%.

During an average follow-up of 11.5 years, more men than women were diagnosed with diabetes: 12.6/1000 person years in men and 8.6/1000 person-years in women.

There was no significant increased risk of developing diabetes if a spouse had diabetes.

However, among these couples in their late 50s and 60s, men with overweight or obese wives had an increased risk of developing diabetes during slightly more than a decade of follow-up.

Having a wife with a BMI of 30 vs a wife with a BMI of 25 increased the risk of developing diabetes by 33% — after adjustment for age, ethnicity, and socioeconomic status (HR, 1.33; 95% CI, 1.23–1.45).

Compared with the men with slimmer wives, men had a 21% increased risk of developing diabetes for every 5-kg/m2-higher BMI the wife had, independent of the man's BMI (HR, 1.21; 95% CI, 1.11–1.33).

The same increased risk of diabetes was seen across the entire weight spectrum, for any 5-unit difference in BMI, Dr Hulman clarified.

However, women who were married to heavier men did not have this increased risk of developing diabetes.

Trajectories of Obesity by Spousal Diabetes Status

In a related study, Omar Silverman-Retana, MD, Aarhus University, Denmark, and colleagues report that "individuals with a spousal history of diabetes have higher levels of obesity beyond the age of 55 years compared with individuals with no spousal diabetes."

This study looked at obesity development with age, "trying to see whether people who have a diabetic spouse are on a steeper obesity curve. It seems that they are at a different level, but not on a steeper curve."

In an email to Medscape Medical News, Dr Silverman-Retana suggested that this might be because people are more likely to choose a partner with similar physical, behavioral, or social characteristics, or partners may develop obesity together.

"From a clinical perspective, this means that there is a potential benefit from targeting couples when advising on health behaviors," he said. "From a public-health perspective, this could translate into couple-based interventions to prevent either diabetes or obesity."

"We're very interested in the social network as a determinant" of diabetes, Dr Witte noted. "In today's approach we're always focusing on the individual — individual questionnaires, genetics — and I think we're missing a layer of information."

The group plans to extend this research to look at social determinants of diabetes in children, parents, and grandparents in Denmark. Spousal relationships "was a good way to start," since it is "the closest social relationship most people have."

The authors disclose that they have no relevant financial relationships.  

European Association for the Study of Diabetes 2017 Annual Meeting; September 11, 2017; Lisbon, Portugal. Abstracts 80, 308

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