What is the clinical evidence from this study?

Study design: Cohort. Population: High risk for type 2 diabetes (n=3234). Intervention: Stressful life events vs. Fewer stressful life events. Primary outcome: Incident type 2 diabetes (HR 1.09, 95% CI 1.02, 1.17).

What does this research mean for the field?

A greater number of stressful life events is associated with a higher risk of developing type 2 diabetes over 21 years, a relationship that is partially mediated by body mass index and waist circumference. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to evaluate the relationship between psychosocial factors and the incidence of type 2 diabetes, along with the mediating effects of body mass index and waist circumference.

June 7, 2026

2328-P: Association of Life Events, Social Support, and Family Functioning with Risk of Developing Diabetes and the Mediating Effects of Body Mass Index (BMI) and Waist Circumference (WC)

Key Result

Each additional 2.5 stressful life events at baseline was associated with a 9% higher risk of developing type 2 diabetes over approximately 21 years (HR 1.09; 95% CI 1.02-1.17).

Key Points

This research aims to evaluate the relationship between psychosocial factors and the incidence of type 2 diabetes, along with the mediating effects of body mass index and waist circumference.
Analyzed data from 3,234 high-risk adults in the Diabetes Prevention Program Outcomes Study.
Participants were randomized to lifestyle, metformin, or placebo, followed for approximately 21 years.
Utilized adjusted Cox models to assess T2D risk and linear mixed-effects models for longitudinal measures.
Each additional 2.5 stressful life events correlated with a 9% higher risk of developing T2D (HR: 1.09; 95% CI: 1.02, 1.17).
Life events impacted changes in adiposity over time, with BMI and waist circumference partially mediating T2D risk (30% association explained).
No significant associations were found with social support or family functioning regarding T2D incidence.

Study Design

Type

Cohort (n=3,234)

Blinding

Unmasked follow-up

Randomization

Randomized to lifestyle, metformin, or placebo (original trial)

Structured PICO

Are stressful life events, social support, and family functioning associated with the risk of developing type 2 diabetes in high-risk adults?

Population

3,234 adults at high risk for type 2 diabetes followed for approximately 21 years to assess the association of psychosocial factors with incident diabetes.

Exposure

Higher number of stressful life events, social support, and family functioning (psychosocial health measures)

Comparator

Lower number of stressful life events / different levels of psychosocial health

Outcome

Incident type 2 diabeteshard clinical

A greater number of stressful life events is independently associated with a higher risk of developing type 2 diabetes over 21 years, a relationship partially mediated by adiposity.

Main Result

Hazard Ratio: 1.09 (95% CI 1.02–1.17)

Abstract

Introduction and Objective: Psychosocial factors play an important role in type 2 diabetes (T2D) risk. Using data from the Diabetes Prevention Program (DPP) Outcomes Study (DPPOS), we evaluated whether psychosocial health (recent life events past year, social support, family functioning) was associated with T2D incidence among high-risk adults, and examined whether adiposity (BMI, WC) mediated these relationships. Methods: Participants were 3,234 adults at high risk for T2D, randomized to lifestyle, metformin, or placebo, and followed for ~3y during DPP and an additional 18y of unmasked follow-up during DPPOS. Self-reported psychosocial measures were collected at baseline. Associations with incident T2D were evaluated using adjusted Cox models, and associations with longitudinal HbA1c, BMI, and WC were assessed using linear mixed-effects models. Results: Each additional 2.5 stressful life events (~1 SD) at baseline was associated with a 9% higher risk of developing T2D (HR: 1.09; 95% CI: 1.02, 1.17) and a 0.045% increase in HbA1c per 5y of follow-up (95% CI: 0.025, 0.065). Associations did not differ by treatment group. Neither social support nor family functioning was associated with T2D incidence or HbA1c. Life events were also associated with changes in adiposity over time. BMI and WC partially mediated the relationship between life events and T2D risk, explaining ~30% of the association, with mediation more pronounced for WC (indirect effect = 0.017) than BMI (indirect effect = 0.014). Conclusion: A greater number of life events was associated with higher T2D risk over ~21y, whereas social support and family functioning were not. Markers of adiposity modestly mediated this relationship. These findings suggest that life events affect T2D risk through multiple pathways and represent an important independent risk factor. Disclosure A.H. Tjaden: None. B. Braffett: None. N. Butera: None. I. Ahmed: None. A. Fulay: None. W. Herman: Other - Member, Data Safety Monitoring Board; Ended; Merck Sharp Current; National Committee for Quality Assurance. M. Temprosa: None. D. Research Group: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) U01 DK048489, National Institute on Aging of the NIH 5 U19 AG078558.

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