Research, partly supported by the EU-funded DYNAHEALTH project, established that, in the men involved, pre-diabetes was found in 19.2% of those employed, 23.0% who’d been unemployed for less than a year and 27.0% of those unemployed for more than a year. The corresponding figures for screen-detected type 2 diabetes were 3.8%, 3.8% and 9.2%.
In women the results were less dramatic, although the numbers did go up slightly in relation to employment. The analogous figures for pre-diabetes were 10.0%, 12.6% and 16.2% and for screen-detected type 2 diabetes 1.7%, 3.4% and 3.6%. In both cases the data were adjusted for education, smoking, alcohol intake, physical activity and body mass index. Among women, associations were attenuated in the adjusted models.
Diabetes is a growing global epidemic which impacts negatively on economies and involves complex interplay between biological, psychological and social factors. As we now know that progression towards type 2 diabetes can be prevented, or delayed, by lifestyle changes in high-risk individuals, identifying those people early enough is vital for timely diagnosis and treatment. The research presents another parameter to be taken into consideration when identifying those at risk.
What is the relation between unemployment and diabetes?
There is a suggestion of a causal link between stress and the onset of type 2 diabetes. Physiologically this is probably provoked by the over-activity of the hypothalamo–pituitary–adrenal (HPA) axis and cortisol production. Behavioural factors will also be playing a role. Occurrence peaks in those between 40-64 and it has been hypothesised that employment-related stressors and the impact of shift work, could underlie its development.
In their paper
published in the journal ‘Primary Care Diabetes’, the researchers observe that while stress relating to employment has been studied, not much work has been done on the impact of unemployment, a known risk factor for poor health. To their best knowledge, say the team, this is the first study to test for the association with objective data for both the exposure to unemployment (national registers) and the outcome of glucose metabolism (OGTT).
The authors outline what they believe to be the key strength of their study as being, ‘(…) the objective register-based quantification of exposure to unemployment during a precise three-year follow-up period preceding an OGTT, capturing the important acute exposure to unemployment-related hardships during the early stages of diabetogenesis. Since the participants are of the same age, the analysis is not biased by temporal macroeconomic fluctuations in general unemployment rates, which may affect the health effects of unemployment.’
Useful pointer for early diagnosis
High exposure to unemployment may predispose middle-aged men to type 2 diabetes. For clinicians, awareness of the patient’s unemployment status may be helpful in recognising undiagnosed cases. DYNAHEALTH (Understanding the dynamic determinants of glucose homeostasis and social capability to promote Healthy and active aging) which supported the research is also capitalising on a number of existing studies harnessing the health, biological and social resource of 1.5 million Europeans. In so doing it is boosting the development of risk-based prevention tools and policies and providing policy-makers with the necessary information on the best periods to invest in cost-effective and sustainable healthcare strategies.
For more information, please see: Project website