If you’re unhappy with your partner, you’re twice as likely to develop diabetes as someone who is happily married or cohabitating, according to a new study presented at 60th Scientific Sessions of the American Diabetes Association in San Antonio. This study, a part of the San Antonio Heart Study, found that marital stress may predict who will develop diabetes in individuals with certain risk factors for the disease.

Of more than 1,200 study participants followed, 15 percent had marriages or live-in relationships that fit the classification of moderately to highly stressful, based on an assessment using the Pearlin and Schooler nine-item scale of perceived marital stress test. Participants were asked to describe their feelings on a scale of one to four, with four being the most negative, when they thought about the pleasures and problems that go into daily life with a spouse or significant other. Individuals with a score of 23 or greater were classified as having a stressful relationship.

The rate of type 2 diabetes among individuals in unhappy relationships was greatest for Hispanics and those with a family history of diabetes, both of which are risk factors for this disease. Mexican Americans with or without a family history of diabetes and non-Mexican Americans with a family history of the disease who reported stressful relationships were the most likely to be affected, notes lead study author Susan P. Fowler, MPH. Even after adjusting for known diabetes risk factors like age, obesity and hypertension, as well as socio-economic and cultural differences that may also influence disease development, the higher rate of diabetes occurrence in people with stressful relationships held true across-the-board, she adds.

None of the study participants were diagnosed with diabetes when the study began. A two-hour glucose tolerance test revealed, however, that those in unhappy relationships had elevated blood plasma levels, compared with people in happier relationships. Follow-up seven to eight years later revealed that 18 percent of those in stressful relationships had developed diabetes, while only nine percent of those in less stressful relationships had developed the disease.

"The study suggests that individuals susceptible to developing diabetes will be the most hard hit by marital stress," says Fowler. She notes that previous studies on the relationship between stress and diabetes indicate that stress may cause an exaggerated response in tissue to stimulate the sympathetic nervous system to develop insulin resistance. So Fowler hypothesizes that possibly, when stress in a relationship triggers onset of diabetes it "may just be a bigger reaction to ‘fight or flight response’ stimuli in those most susceptible to diabetes."

But don’t leave your lover in hopes of saving your health, warns Fowler. The same study found a higher rate of diabetes among those who had later divorced or separated or had been widowed. Overall, the rate of diabetes was 34 percent greater in this group, but occurrence of diabetes in non-Hispanics who had let a stressful relationship was more than twice that of individuals who had stayed with their partners.

Fowler, therefore, suggests that people in stressful relationships, especially those at risk for developing diabetes, do whatever is necessary to heal their relationships and stay physically and emotionally healthy. "Seek marriage counseling; eat a healthy diet, practice stress management techniques like exercise or mediation, or go church or find some other spiritual activity," she concludes.

Editorial Commentary: Stress of varying kinds has been shown to elevate blood sugar levels. Marital stress can be particularly troubling. Stress can increase blood sugar levels by increasing stress hormones but it can also lead to less healthy behaviors, such as increased eating and less exercise. It is important that people who are at risk for developing diabetes get tested yearly or more often if they develop symptoms of diabetes whether or not they are under unusual stress. Risk factors for diabetes include being overweight, having a family history of diabetes, a personal history of having gestational diabetes or having a baby weighing greater than nine pounds, or being from a high risk ethnic group such as African Americans, Hispanic Americans or American Indians. Symptoms of diabetes include excessive thirst or hunger, frequent urination, especially at night, unintentional weight loss or recurrent yeast infections (in women).

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