Living with a spouse or cohabitating with a partner may help middle-aged and older adults keep their blood glucose levels in check, new research suggests.
And it doesn't even have to be an ideal union. Just having a relationship seems to provide benefit whether partners described it as supportive or strained.
Katherine J. Ford, PhD, with the Department of Psychology at Carleton University in Ottawa, Ontario, Canada, led the study, which was published online today in BMJ Open Diabetes Research & Care.
The team used data from more than 3335 people from 2004 to 2013 in the English Longitudinal Study of Ageing (ELSA), a population-based sample of adults in England aged 50-89 years old and their partners. A1c values were regularly collected in the ELSA cohort.
Participants did not have previously diagnosed diabetes. They were asked over a decade about whether they had a wife, husband, or partner and whether there had been a change in their partnership status.
They were also asked standardized questions to determine the support or strain of the relationship, such as whether one partner felt the other understood his or her feelings or how much the spouse let the respondent down.
Ford told Medscape Medical News there was improvement, an average 0.21% decrease in A1c, when participants transitioned into a marriage or domestic partnership, and the same percentage increase in A1c when participants transitioned out of the relationship.
To put the results into context, researchers say other studies suggest a decrease of 0.2% in the population average A1c value "would decrease excess mortality by 25%."
So the data may have messages for middle-aged and older adults and physicians, and even public health, said Ford. "It may inspire extra monitoring and questions about relationships in the exam room if a patient is going through a marital transition."
"Likewise, if older adults want to pursue romantic relationships and new partnerships, that should also be supported," she said.
Potential Reasons for Benefit
So how might marriage status affect blood glucose?
Ford said reasons cited in the literature include that "when people are experiencing stress in their life, having the social support of someone could help reduce that stress."
The comfort of sharing expenses, such as housing, food, and insurance, may also reduce stress, she said.
"One partner might be more interested in healthy eating and that, sort of, by osmosis, may influence the other partner in terms of their lifestyle choices as well," Ford added.
Other health benefits of living with a partner, particularly in older age, have been well-documented in other studies. And research has linked type 2 diabetes risk with lack of social support, loneliness, and isolation.
But those factors are complex and less easily documented, so the researchers focused on A1c levels.
They adjusted for potential confounders, such as whether the participants were retired or currently working and whether they reported depression or had changes in body mass index over time.
The authors note that their observational study couldn't establish that marriage status causes differences in blood glucose levels.
It "can't be ruled out," the authors acknowledge, that it could be the other way around: that worsening health from increased A1c levels may have made people more likely to get divorced, for instance.
However, they write, this seems unlikely "given that symptoms of type 2 diabetes can be mild or absent for many years."
"We also ran a sensitivity analysis excluding all participants who went on to develop diabetes over the study period and found no significant deviation from our main results," they note.
The researchers conclude: "Overall, our results suggested that marital/cohabitating relationships were inversely related to A1c levels regardless of dimensions of spousal support or strain. Likewise, these relationships appeared to have a protective effect against A1c levels above the prediabetes threshold."
A strength of the study is that it used A1c instead of a measure that relies on self-reported data.
A study limitation is that the ELSA database includes primarily White participants, so it is unclear whether the study conclusions are generalizable to other races or ethnic groups, Ford said.
The data also did not include information on sexual orientation, she said.
The authors have reported no relevant financial relationships.
BMJ Open Diabetes Res Care. 2023;11:e003080. Full text
Marcia Frellick is a freelance journalist based in Chicago. She has written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, Cincinnati Enquirer, and St. Cloud (Minnesota) Times. Follow her on Twitter: @mfrellick
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Cite this: Relationships, Good or Bad, Help Keep Blood Glucose on Target - Medscape - Feb 06, 2023.