PerspectiveIn the Journals

Diabetes diagnosis in one spouse may increase risk in other

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January 24, 2014

Patients who have a spouse with diabetes could have a greater risk for developing the disease, data from a recent systematic review and meta-analysis suggest.

“When we talk about family history of type 2 diabetes, we generally assume that the risk increase that clusters in families results from genetic factors. What our analyses demonstrate is that risk is shared by spouses. This underscores the effects of shared environments, attitudes and behaviors, which presumably underlie the shared risk. Our results are not the finding of a single study but rather a synthesis of the existing studies,” Kaberi Dasgupta, MD, of the Research Institute of the McGill University Health Centre and an associate professor of medicine at McGill University in Montreal, said in a press release.

Of 2,705 articles obtained through Medline, Embase or Scopus databases from January 1997 to February 2013, the researchers identified six articles (n=75,498 couples) for systematic review and five articles for their meta-analysis.

“We found a 26% increase in the risk of developing type 2 diabetes if your spouse also has type 2 diabetes,” Dasgupta said. “This may be a platform to assist clinicians to develop strategies to involve both partners. Changing health behavior is challenging and if you have the collaboration of your partner it’s likely to be easier.”

Researchers found that the association was lowest in one study that was dependent on the women’s reports of diabetes in themselves and their spouses (effect estimate: 1.1; 95% CI, 1-1.3) and highest in a study with systematic assessment of glucose tolerance (2.11; 95% CI, 1.74-5.1).

The researchers made adjustments for age and other covariates, but not BMI, and reported that the random-effects pooled estimate was 1.26 (95% CI, 1.08-1.45), according to data.

However, when BMI was included, the estimate was lower (1.18; 95% CI, 0.97-1.4), researchers wrote.

Two studies that used glucose testing to determine diabetes status appeared to have a greater risk for spousal association (OR=1.92; 95% CI, 1.55-2.37) without BMI adjustments and an increased risk when it was included (OR=2.32; 95% CI, 1.87-3.98), according to data.

Although two studies did not distinguish between the types of diabetes in adult patients, the researchers reported it would not have a significant effect on the final outcome of the study.

“Future studies need to strengthen the understanding of shared couple risk further. For example, interventions that seek to lower diabetes risk by addressing eating and physical activity behaviors and home food environments could potentially be strengthened by strategies that engage both partners,” Dasgupta said.

Disclosure: The researchers report no relevant financial disclosures.

itj+ Perspective

Ronald Tamler

Ronald Tamler

It is well-established that a family history of diabetes is a strong risk factor for developing diabetes; a parent with diabetes doubles the risk, and a sibling with diabetes triples it. The meta-analysis by Leong and colleagues evaluated five quite heterogeneous studies, sometimes relying on diabetes by report (where the condition is notoriously underrepresented), and sometimes on lab results indicating the diagnosis. The analysis was dominated by a single study from China with 66,000 subjects. The moderate increase in diabetes concordance among spouses was much lower than what I would have expected from observing my own clinical practice, where husbands and wives frequently share diabetes supplies. I do like to have the spouse present for part of the visit to get a sense of the patient’s situation at home and barriers to care. Should I now screen that spouse for diabetes while he or she is in the office? Let me ponder while I finish my wife’s meal.

Ronald Tamler, MD, PhD, MBA, CNSC, CDE
Endocrine Today Editorial Board Member;
Clinical Director, Mount Sinai Diabetes Center at The Mount Sinai Hospital;
Associate professor of medicine, division of endocrinology, diabetes and bone diseases at the Icahn School of Medicine at Mount Sinai

Disclosure: Tamler reports no relevant financial disclosures.