Religion and Spirituality Not Significantly Associated with Reduced Incidence of T2D

Women who attended religious service had a similar incidence of T2D compared to those that did not.

Most diabetes research examines the effects of medication therapy and lifestyle choices on T2D. However, many other psychosocial effects play an essential role in this complicated disease. For example, a previous cross-sectional study found an inverse relationship between the strength of spiritual beliefs and T2D [odds ratio (OR)=0.91, confidence interval (CI)=0.87-0.94]. In addition, a Canadian cross-sectional study found that people who attended religious services more than once a week had a lower prevalence of T2D compared to people attending less than once a year (OR=0.60, CI=0.45-0.80). Confoundingly, another cross-sectional survey found increased odds of T2D among people attending religious services at least once weekly (OR=1.73, CI=1.11-2.70) compared to those not attending. The researchers of this study conducted a long-term prospective study that looked at the relationship between religious coping, participation in organized religion, and the occurrence of T2D.

This fourteen-year study analyzed 42,825 female registered nurses living in the United States. It utilized the Nurses’ Health Study II (NHS II), a twice-yearly questionnaire that gathered data on demographics. Exclusion criteria consisted of females missing a birthdate (n=7), diagnosed with a cardiovascular disease (n=2,819), non-melanoma cancer (n=2,901), T2D (n=833), other diabetes (n=316), prior diabetes medication use (n=286), no response to religious/spiritual (R/S) coping question (n=825). The survey analyzed R/S by asking individuals how often they attended religious services and found comfort in their religion or spiritual beliefs. Women also self-reported any physician diagnosis of T2D on their biennial questionnaire. A supplementary questionnaire was sent out, asking about the date of diagnosis, symptoms, diagnostic test results, and hypoglycemic therapy. The researchers examined the correlation between R/S and T2D using Cox proportional hazard ratios (HR) and 95% confidence intervals (CI).

Regarding baseline characteristics, only females were studied. Participants were mostly white (94%), with a mean age of forty-seven years. Most of the women were from high-income households [<$50,000 (13%), $50,000-74,999 (23%), 75,000-99,999 (18%), >100,000 (31%)]; had a BMI of 18.5-22.9 (33%), never smoked cigarettes (67%), and didn’t consume alcohol (37%). Many respondents attended religious service at least once weekly (44.9%), with fewer rarely or never attending (24.6%). Similarly, many used spiritual coping (43.3%), with fewer indicating never using it (9.4%).

The researchers found that religion or spirituality was not significantly associated with T2D. There was no difference between women who never or seldom attended religious services and those who attended <1 per month (HR=1.06, CI=0.92-1.22), 1-3 times per month (HR=1.00; CI=0.85-1.17), and once weekly (HR=0.98; CI: 0.85-1.14). In addition, there was no significant effect modification of R/S coping (fully adjusted P interaction=0.54), religious service attendance (fully adjusted P interaction=0.63), and T2D. 

This prospective cohort study found no association between religious service attendance, religious or spiritual coping, and the incidence of T2D. These findings were consistent with other smaller studies, including the CARDIA prospective cohort study and the multinational European SHARE prospective cohort study. Strengths of the research include large sample size, longitudinal design, and fourteen years of follow-up. They also used two measures for R/S coping and three measures of religious service attendance. Limitations include the demographics, which mainly comprised white and middle-aged females. Some information was also excluded due to incomplete data on the survey. The participants who did not answer the R/S questions were more likely to not respond to income and child abuse questions. There was no distinction between religious denominations, which might have affected the results. The researchers believe future high-quality prospect studies need to examine social mechanisms of action in religion alongside various chronic diseases.

 Practice Pearls:

• There are conflicting findings between associations of attending religious services and the prevalence of T2D.
• The researchers found that religion or spirituality was not significantly associated with T2D. There was no difference between women who never or rarely attended religious services and those who attended <1 per month, 1-3 times per month, and once weekly.
• The researchers of this study found their findings consistent with other smaller studies, including the CARDIA prospective cohort study and the multinational European SHARE prospective cohort study.

Banerjee AT, Boyle MH, Anand SS, Strachan PH, Oremus M. The relationship between religious service attendance and coronary heart disease and related risk factors in Saskatchewan, Canada. J Relig Health. 2014;53(1):141-56. https://pubmed.ncbi.nlm.nih.gov/22576676/

Spence, Nicholas D, et al. “Religious or spiritual coping, religious service attendance, and type 2 diabetes: A prospective study of women in the United States.” Annals of epidemiology, S1047-2797(21)00304-5. 22 Sep. 2021, doi:10.1016/j.annepidem.2021.09.012.

Author: Kornelia Ilias, Pharm.D. Candidate, Creighton University School of Pharmacy and Health Professions