‘Couple-focused’ strategies may help prevent type 2 diabetes development
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Couple-based strategies for type 2 diabetes prevention may be more effective than current individual-based approaches for spouses, according to data presented at the European Association for the Study of Diabetes Annual Meeting.
“We know that spouses are likely to be concordant in type 2 diabetes risk and the corresponding risk factors, but until now these had only been studied at a general level,” Omar Silverman-Retana, MD, MSc, a former doctoral student in the department of public health at Aarhus University, currently affiliated with the Steno Diabetes Center Aarhus, told Healio. “Previous studies generally assessed only a few determinants each, not all of them together. We wanted to understand where in the causal cascade leading to type 2 diabetes spousal similarities are greatest by studying a set of very detailed indicators of diabetes risk at different levels. We were interested in understanding which of these factors might be good candidates to target in future couple-focused prevention strategies.”
In a cross-sectional study, Silverman-Retana and colleagues analyzed data from 172 couples who participated in the Maastricht Study, an extensive phenotyping study that focuses on the etiology of type 2 diabetes and its complications. Researchers used quantile regression models to assess spousal concordance in pathophysiological mechanisms of type 2 diabetes, including beta-cell function and insulin sensitivity. Risk factors included four adiposity measures, two dimensions of physical activity, sedentary time and two diet indicators. Researchers also assessed fasting glucose, 2-hour plasma glucose and HbA1c.
The strongest spousal concordance for the Dutch Healthy Diet Index (DHDI) was for men, meaning that a 1 U increase in wives’ DHDI was associated with a 0.53 U difference in the men’s DHDI (95% CI, 0.22-0.67). Among women, the strongest concordance was for the time spent in high-intensity physical activity, meaning a 1 U increase in husbands’ time spent in high-intensity physical activity was associated with a 0.36 U difference in women’s time spent in high-intensity physical activity (95% CI, 0.17-0.64). The weakest spousal concordance was observed in beta-cell function indices, Silverman-Retana said.
“There are two main messages,” Silverman-Retana said. “First, couple-based strategies for type 2 diabetes prevention might potentially be more effective than the current individual-based approach for type 2 diabetes prevention. Second, the design of innovative couple-based interventions for type 2 diabetes prevention could benefit from targeting the factors where we found the strongest spousal similarities: the health-related behaviors such as diet and physical activity.”
Silverman-Retana said the Maastricht Study is characterized by an extensive phenotyping approach of type 2 diabetes and collected data on social networks, allowing the researchers to identify spouses who had both participated in the study.
“The high level of detail and the broad number of indicators we have included in this study are one of the strengths,” Silverman-Retana said. “For example, beta-cell function markers were derived using a seven-point oral glucose tolerance test, and physical activity and sedentary behavior were measured using 7-day accelerometers.
In a press release, the researchers noted that public health prevention strategies to mitigate diabetes risk may benefit from spousal similarities in health-related behaviors and diabetes risk factors to design innovative and potentially more effective couple-based interventions.
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Silverman-Retana O, et al. Abstract #332. Presented at: EASD Annual Meeting; Sept. 21-25, 2020 (virtual meeting).
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