Experiences of loneliness among people with a diagnosis of 'personality disorder': A qualitative interview study in the UK.

Type 2 diabetes mellitus (T2DM) is one of the most common chronic metabolic diseases among older adults and is mainly characterized by insulin resistance and progressive pancreatic β-cell dysfunction. With population ageing and lifestyle changes, the burden of T2DM among older adults has become increasingly prominent. In China, diabetes affects approximately 30% of individuals aged 60 years and above, and more than 95% of these cases are type 2 diabetes [,]. Older adults with T2DM often require long-term pharmacological treatment, lifestyle modification, blood glucose monitoring and continuous self-management. In addition, age-related functional decline and diabetes-related complications, such as cardiovascular, cerebrovascular, renal and peripheral vascular complications, may further increase their physical, psychological and social burden []. For older adults, T2DM is not only a biomedical condition but also a long-term life event that may reshape daily routines, family roles and social participation []. Strict dietary control, medication adherence, fear of hypoglycaemia, reduced physical mobility and concerns about complications may limit opportunities for social interaction. Some patients may gradually reduce participation in family, community or recreational activities because of fatigue, physical discomfort, perceived stigma or lack of confidence in managing diabetes outside the home. Over time, these experiences may place older adults with T2DM at increased risk of social isolation. Social isolation generally refers to insufficient social contacts, limited social networks and reduced engagement in social relationships or social activities. It is conceptually distinct from loneliness, which reflects a subjective feeling of dissatisfaction with one’s social relationships [,]. In older adults with chronic illness, social isolation may arise from the interaction of disease-related limitations, psychological distress, reduced mobility, family support changes and environmental barriers []. Therefore, social isolation should not be understood simply as an individual’s voluntary withdrawal, but rather as a multidimensional phenomenon shaped by health, psychological, interpersonal and social contexts.Increasing evidence suggests that social isolation is associated with adverse health outcomes in individuals with diabetes. Previous studies have reported that social isolation and loneliness are associated with a higher risk of diabetic microvascular complications, and that these associations may be comparable in importance to several traditional lifestyle-related risk factors []. Other research has shown that individuals with diabetes who experience higher levels of social isolation tend to have poorer glycaemic control, including higher fasting blood glucose and glycated haemoglobin levels []. These findings indicate that social isolation may be an important and potentially modifiable social determinant of health among people with T2DM.