Loneliness as a Predictor for Type Two Diabetes
Loneliness as a Predictor for Type 2 Diabetes
Amelia Henriquez
University of Ottawa
PSY 4391 A
Dr. Serena Corsini-Munt
Henriquez 1
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This past year individuals all over the world have been separated from their loved ones
and have been dealing with the subsequent impacts of self-isolation. These circumstances have
inspired many researchers to explore how loneliness and isolation impacts our health. In a media
article by diabetes.co.uk a hypothesis is put forward by researchers from King’s College London
that suggests the possible link between loneliness and type 2 diabetes in adults over the age of 50
years old. The researchers from this longitudinal study describe loneliness as a “ lack of
meaningful connections with people” (Hackett et al., 2020) and go onto explain that it could be a
predictor for type two diabetes. In this paper I will be critically evaluating the current literature
from King's College London on diabetes and loneliness which supports my thesis that loneliness
acts as a significant predictor for type 2 diabetes in older adults.
Dr. Hackett, one of the primary researchers for this study, explains that the need for
research on how loneliness affects our health is needed now more than ever as we navigate
isolation and loneliness during the Covid-19 pandemic. Hackett speaks on this need for research
as “it is likely that many more people were experiencing this difficult emotion during this
period.” (Hackett, 2020). Based on previous research we know that loneliness can have
devastating effects on our health including all-cause mortality and coronary heart disease (RicoUribe et al., 2018). As well as loneliness being negative for our health, certain models outline
how beneficial social support can be for our health. The Main effects model outlines how social
support is generally beneficial to our health and well-being, and the Buffering model states that
Social support reduces stress and its negative effects on one’s health (Hadjistavropoulos, T. et
al., Stress, Coping, and Health 2019). Based on these models and previous research Hackett
aimed to explore the interaction between loneliness and health effects, however her team of
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researchers make an important distinction between isolation and loneliness because although
they may overlap they are not the same “isolation or living alone does not predict type 2 diabetes
whereas loneliness, which is defined by a person’s quality of relationships, does.” (Hackett,
2020). The aim of this study was to address what previous research did not and to test the
potential link between loneliness and type two diabetes onset.
Hackett et al. tested this hypothesis using a longitudinal observational study with 4112
diabetes-free participants over the age of 50 (mean age 65.02 ± 9.05) living in London, England.
Data was derived from self-reports in the form of questionnaires and interviews which were
taken at each wave of the study biennially. Loneliness was initially addressed using the valid
revised University of California Los Angeles (UCLA) Loneliness Scale (Russell et al., 1978).
Items on this scale include questions such as ‘How often do you feel you lack companionship?’
with responses of 1, ‘hardly ever/never’; 2, ‘some of the time’; and 3, ‘often’. A total of N=264
participants were later diagnosed with type 2 diabetes at the 12 year follow-up point in the study.
Based on participants previous ratings from the UCLA Loneliness scale, loneliness was shown to
be a significant predictor for type 2 diabetes (HR 1.46; 95% CI 1.15, 1.84; p = 0.002). The raw
data from this study were analysed using t tests for continuous variables and χ2 tests for
categorical variables comparing those who had a type 2 diabetes diagnosis and those who did
not. The relationship between loneliness and sample characteristics were then analysed using
Pearson’s correlations for continuous variables and univariate ANOVAs for categorical
variables. Additionally, researchers eliminated the possibilities of reverse causality through
excluding participants who developed diabetes within 2 years of the beginning of the study.
These results were also shown to be independent of depressive symptoms, living alone and social
isolation. As was previously mentioned Hackett made an important distinction between being
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alone and feeling lonely, and the results are consistent with this claim as living alone and social
isolation did not have a significant association with the onset of type 2 diabetes. One limitation
of this study is that it is not completely understood why there is a relationship between loneliness
and type 2 diabetes however it is hypothesized by Hackett that chronic loneliness may be putting
the stress system into overdrive which may be responsible for this relationship. She explains that
“over time that leads to wear and tear on your body and those negative changes in stress related
biology may be linked to type 2 diabetes development” (Hackett, 2020). This statement is
consistent with findings from other research in this area with Hawkley et al. (2010) claiming
“loneliness is characterised by maladaptive hypervigilance for social threats”. This research from
Hawkley also shows a relationship between the maladaptive hypervigilance of loneliness and
poor health outcomes.
Although Hackett and her team are the first to specifically test the relationship between
loneliness and type 2 diabetes, there have been several cross-sectional studies that yield similar
results (Richard et al., 2017). However the issue with these cross-sectional studies is that
causality cannot always be determined. In other words, it is hard to determine if loneliness leads
to type 2 diabetes onset, or if loneliness is a result of the strain of diabetes diagnosis on the
individual and their social relationships. Hackett highlights this issue in the current study, as the
study is observational in nature issues with causality can often occur. Researchers also note that
considering that depression and loneliness have often been thought of to have a reciprocal
relationship, in this study depressive symptoms were considered a confounding variable. Results
still show that loneliness is a significant predictor for type 2 diabetes independent of depressive
symptoms. Another limitation of this study is that a large majority of the participants were
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reported to be white, with very few ethnc minorities. More research would be needed to
generalize to a larger and more ethnically inclusive population.
In summary, researchers at King’s College London found loneliness to be a statistically
significant predictor for type 2 diabetes in adults over the age of 50 based on their findings from
a longitudinal study spanning across 15 years. This research opens the door for future
exploration into the topic of how loneliness impacts our biological, psychological, and social
health. Overall, I believe diabetes.co.uk did a good job at summarizing the key findings from this
study and conveying the important message that chronic loneliness has shown to be linked with
devastating health problems such as diabetes and coronary heart disease, and that forming
meaningful connections to others may act as a preventive tool for future health issues. An
important takeaway from this research is how social isolation itself is not a significant predictor
of type 2 diabetes. In other words, being alone does not necessarily have a negative impact on
our health, but the lack of social support and feelings of loneliness does. This is consistent with
previously mentioned models of social support, and highlights how truly crucial it is to have a
good social support system. Future considerations for clinicians would be to take these findings
and ensure that their patients have a quality support system, in prevention for health problems as
well as a form of coping for when these health problems should occur.
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References
Hackett, R.A., Hudson, J.L. & Chilcot, J. Loneliness and type 2 diabetes incidence: findings
from the English Longitudinal Study of Ageing. Diabetologia 63, 2329–2338 (2020).
https://doi.org/10.1007/s00125-020-05258-6
Rico-Uribe LA, Caballero FF, Martín-María N, Cabello M, Ayuso Mateos JL, Miret M (2018)
Association of loneliness with all-cause mortality: a meta-analysis. PLoS One
13(1):e0190033. https://doi.org/10.1371/journal.pone.0190033
Russell, D , Peplau, L. A.. & Ferguson, M. L. (1978). Developing a measure of loneliness.
Journal of Personality Assessment, 42, 290-294.
Richard A, Rohrmann S, Vandeleur CL, Schmid M, Barth J, Eichholzer M (2017) Loneliness is
adversely associated with physical and mental health and lifestyle factors: results from a
Swiss national survey. PLoS One 12(7):e0181442.
https://doi.org/10.1371/journal.pone.0181442
Hawkley LC, Cacioppo JT (2010) Loneliness matters: a theoretical and empirical review of
consequences and mechanisms. Ann Behav Med Publ Soc Behav Med 40(2):218–227.
https://doi.org/10.1007/s12160-010-9210-8
Hadjistavropoulos, T., & Hadjistavropoulos, H. D. (2019). Stress, Coping, and Health. In
Fundamentals of health psychology. Don Mills, Ontario, Canada, ON: Oxford University
Press.
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