Loneliness and biological responses to acute stress in people with Type 2 diabetes

Abstract

Loneliness is linked with all‐cause mortality and coronary heart disease. Altered neuroendocrine and inflammatory responses to stress constitute potential pathways linking loneliness and ill‐health. Stress responsivity is modified in people with Type 2 diabetes, but it is unclear whether loneliness influences biological stress responses in this population. We assessed interleukin‐6 (IL‐6), interleukin‐1 receptor antagonist (IL‐1RA), monocyte chemoattractant protein‐1 (MCP‐1), and cortisol responses to acute stress in 135 people with Type 2 diabetes. Loneliness was measured used the Revised UCLA Loneliness Scale. Loneliness was inversely associated with cortisol output poststress ( B = −4.429, p = 0.019) independent of age, sex, education, marital status, body mass index, and smoking. Lonelier individuals had raised MCP‐1 concentrations 75 min poststress independent of covariates ( B = 0.713, p = 0.022). No associations between loneliness and IL‐6 or IL‐1RA concentrations were detected. These results suggest that loneliness is associated with disturbances in stress responsivity in people with diabetes, and the impact of loneliness on health in people with diabetes may be mediated in part through dysregulation of inflammatory and neuroendocrine systems. Future research is required to understand if such changes increase the risk of poorer outcomes in this population.

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

“…Loneliness is also associated with inflammation [36], which is of relevance to type 2 diabetes as pooled evidence suggests that heightened inflammation is a risk factor for the condition [37]. Indeed, loneliness has been associated with heightened inflammation in laboratory settings in people with diagnosed type 2 diabetes [35].…”

“…Cortisol plays an important mechanistic function related to type 2 diabetes [ 7 ] and dysregulation in daily cortisol output is predictive of new onset pre-diabetes and type 2 diabetes [ 34 ]. In samples with overt type 2 diabetes, loneliness has been associated with dysregulation in cortisol responses to acute laboratory stress [ 35 ]. Loneliness is also associated with inflammation [ 36 ], which is of relevance to type 2 diabetes as pooled evidence suggests that heightened inflammation is a risk factor for the condition [ 37 ].…”

Relationship between loneliness and blood glucose control in diabetes

“…We assessed the relationships between loneliness and metabolic control indicators. Available studies indicate that HbA1c and BMI were the most common metabolic control indicators assessed in relation to loneliness [ 12 , 14 , 21 , 22 ]. An assessment of the relationship between loneliness and treatment adherence in diabetic patients showed a correlation between loneliness and postprandial blood glucose levels in these patients.…”

“…Similarly to our study, no correlation was shown between HbA1c and BMI [ 21 ]. Also, no relationship was demonstrated between loneliness and these indicators in a study assessing the severity of already impaired response to stress in T2DM patients [ 14 ]. Although the relationship between loneliness and long-term control of glucose levels assessed based on HbA1c was not confirmed by Niemcryk [ 22 ], the importance of loneliness in T2DM patients in terms of following a healthy diet was confirmed during an attempt to identify predictors of long-term blood glucose control [ 12 ].…”

“…We also assessed the relationship between loneliness and inflammatory/neuroendocrine responses to acute stress in elderly patients with T2DM. The authors of the study showed that loneliness was associated with disturbed responses to stress in diabetic patients, which may partly result from disregulation of the inflammatory and neuroendocrine systems [ 14 ]. An assessment of peer support from the perspective of adults with type 1 diabetes revealed a conviction that diabetes is present in all aspects of patients’ lives.…”