Systematic Review on the Association of Loneliness and Social Isolation With Diabetes Mellitus
Author(s)
Sibylle Puntscher, Dr.1, veronika papon, MSc1, Sophia Spagl, MPH1, Marjan Arvandi, Dr.phil.1, Beate Jahn, Assoc.-Prof. PD Dr.1, Kaisu H. Pitkälä, MD, PhD, professor emerita2, Laura Coll-Planas, Prof.3, Iva Holmerova, PhD4, Alzbeta Bartova, MSc4, Blanka Novotna, MSc4, Cristina Casajuana-Kögel, MSc5, Matthew Jones, Prof.6, Jill S. Litt, Prof., PhD7, Uwe Siebert, Univ.-Prof., Dr., MPH, MSc8, Ursula Rochau, Assoc.Prof. PD Dr.1.
1Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall in Tirol, Austria, 2Department of General Practice and Primary Health Care, University of Helsinki, Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland, 3University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain, 4Charles University, Prague, Czech Republic, 5Public Health Agency of Catalonia, Barcelona, Spain, 6University of the West of England, Bristol, United Kingdom, 7Institute for Global Health (ISGlobal); CIBER Epidemiología y Salud Pública (CIBERESP); Universitat Pompeu Fabra (UPF), Barcelona, Spain, 8Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria; Harvard Chan School of Public Health, Boston, MA, United States; Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
1Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall in Tirol, Austria, 2Department of General Practice and Primary Health Care, University of Helsinki, Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland, 3University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain, 4Charles University, Prague, Czech Republic, 5Public Health Agency of Catalonia, Barcelona, Spain, 6University of the West of England, Bristol, United Kingdom, 7Institute for Global Health (ISGlobal); CIBER Epidemiología y Salud Pública (CIBERESP); Universitat Pompeu Fabra (UPF), Barcelona, Spain, 8Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria; Harvard Chan School of Public Health, Boston, MA, United States; Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
OBJECTIVES: Loneliness and social isolation are recognized as psychosocial factors that may influence the development of chronic diseases, such as diabetes mellitus (DM). Our systematic review aimed to synthesize longitudinal evidence on the association between loneliness, social isolation, and DM in adults. This study is part of the EU-Horizon 2020 project RECETAS.
METHODS: To identify relevant studies, a comprehensive search was performed in PubMed, PsycINFO, and Web of Science, focusing on longitudinal, quantitative research published in English or German after 2003. Eligible studies assessed the association of loneliness or social isolation with DM in adults. Two reviewers independently performed screening, data extraction, and quality assessment using the Newcastle-Ottawa Scale (NOS). Relevant information was extracted and synthesized in a comprehensive evidence table.
RESULTS: Out of 940 studies screened, twelve were reviewed in full text, and six studies met inclusion criteria. All were published after 2017, used prospective cohort designs, and focused on type 2 DM (T2DM). The studies originated from the United Kingdom (n=2), China (n=1), Norway (n=1), Germany (n=1), Australia (n=1), and Denmark (n=1). Sample sizes ranged from 4,112 to 437,303 participants, with diabetes incidence between 1.8% and 9%. Five studies investigated loneliness and reported a significant association with T2DM. Four studies examined social isolation and three of them also found a significant association with T2DM onset. Statistical analyses included Cox-proportional hazards models, logistic regression, and generalized estimating equations. All studies were rated as good quality based on the NOS.
CONCLUSIONS: Evidence from longitudinal studies indicates that loneliness and social isolation are associated with an increased risk of T2DM. Research suggests this may be driven by social stress, which can increase carbohydrate intake and suppress insulin levels - both of which contribute to diabetes risk. These findings highlight the importance of addressing psychosocial factors in diabetes prevention strategies.
METHODS: To identify relevant studies, a comprehensive search was performed in PubMed, PsycINFO, and Web of Science, focusing on longitudinal, quantitative research published in English or German after 2003. Eligible studies assessed the association of loneliness or social isolation with DM in adults. Two reviewers independently performed screening, data extraction, and quality assessment using the Newcastle-Ottawa Scale (NOS). Relevant information was extracted and synthesized in a comprehensive evidence table.
RESULTS: Out of 940 studies screened, twelve were reviewed in full text, and six studies met inclusion criteria. All were published after 2017, used prospective cohort designs, and focused on type 2 DM (T2DM). The studies originated from the United Kingdom (n=2), China (n=1), Norway (n=1), Germany (n=1), Australia (n=1), and Denmark (n=1). Sample sizes ranged from 4,112 to 437,303 participants, with diabetes incidence between 1.8% and 9%. Five studies investigated loneliness and reported a significant association with T2DM. Four studies examined social isolation and three of them also found a significant association with T2DM onset. Statistical analyses included Cox-proportional hazards models, logistic regression, and generalized estimating equations. All studies were rated as good quality based on the NOS.
CONCLUSIONS: Evidence from longitudinal studies indicates that loneliness and social isolation are associated with an increased risk of T2DM. Research suggests this may be driven by social stress, which can increase carbohydrate intake and suppress insulin levels - both of which contribute to diabetes risk. These findings highlight the importance of addressing psychosocial factors in diabetes prevention strategies.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH225
Topic
Epidemiology & Public Health, Study Approaches
Topic Subcategory
Public Health
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), Mental Health (including addition)