Role of psychosocial factors of health in clinical trial retention, diabetes incidence, and weight change in prediabetes and type 2 diabetes
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Psychosocial factors have considerable impacts on health and particularly on risk and management of type 2 diabetes (T2D), a leading chronic disease in the U.S. Understanding the individual roles of recent life events, social support, and family functioning is critical, however, additional information may be gained when considering their dynamic interplay within the context of prediabetes and diabetes. These psychosocial domains are interconnected, creating a complex web of influences that can shape both participation in clinical trials and disease risk over time. Utilizing data from the Diabetes Prevention Program (DPP) and DPP Outcomes Study (DPPOS), we explored the relationship between psychosocial aspects of health including recent life events, perceived social support, and family functioning with clinical trial adherence and retention, diabetes development, and adiposity in persons at high-risk for development of or living with type 2 diabetes (T2D). The first study examined the distribution of and inter-relationships between recent life events, perceived social support, and family functioning among participants with prediabetes and T2D in the DPP. Several key sociodemographic characteristics were associated with prevalence of recent life events, perceived social support, and family functioning. Using k-means and hierarchical clustering, participants clustered into two subgroups – those who were psychosocially supported with fewer recent life events, more social support and healthier family functioning and those who were psychosocially constrained. The second study used logistic regression and Cox proportional hazards models to evaluate the association of baseline sociodemographic, clinical and psychosocial factors (life events, family functioning, social support) with short-term retention (~3y) and time-to-dropout over twenty years of follow-up. Study retention was associated with older age, psychosocial factors, T2D development, and lower BMI. The third study examined the relationship between psychosocial aspects of health (recent life events, perceived social support, and family functioning), measures of adiposity over time, and diabetes incidence. We determined the association between psychosocial factors and diabetes incidence with Cox proportional hazard models. Using linear mixed effects models, we assessed the relationship of psychosocial factors and with longitudinal measures of glycemia with HbA1c, and measures of adiposity represented by body mass index [BMI] and waist circumference [WC]. We evaluated whether BMI or WC mediate the relationship between the psychosocial factors and diabetes risk and whether any of the observed relationships differed by assigned treatment group. A higher number of recent life events reported was associated with an increased risk of diabetes, as well as with higher HbA1c and increased adiposity over time. Neither family functioning nor social support were consistently associated with diabetes risk or repeated measures of HbA1c. In mediation analyses, we observed that recent life events appeared to influence diabetes risk, partially through their effect on adiposity (as measured using BMI or WC) suggesting that life events affect risk of diabetes through various mechanisms, with adiposity being just one pathway. Supplemental analyses employed latent class growth modeling to identify distinct trajectory classes of BMI and WC. The results and findings from this research could have a significant public health impact on persons at high-risk for or living with T2D. Results of the first analysis provide researchers insight into the psychosocial profiles of at-risk participants that may influence their vulnerability to chronic disease and their potential for successful prevention. Findings from the second analysis not only show that twenty-year retention of a racially and geographically diverse cohort with prediabetes is possible but also that a number of factors are related with retention including often overlooked psychosocial factors. Results from the third study provide evidence that adiposity, particularly WC, significantly mediates the relationship between life events and diabetes risk, though explains relatively little of how life events affect the development of diabetes. These findings highlight a need for future research to better understand the mechanisms through which life stress affects the risk of diabetes.
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