The Impact of Social Worker Referrals on Diabetes and Loneliness

The Impact of Social Worker Referrals on A1C for Seniors With Diabetes Experiencing Loneliness: A Randomised Controlled Trial

The goal of this clinical trial is to learn if referral to a social worker (social prescribing) can help reduce loneliness and improve blood sugar control (A1C) in older adults with diabetes. It will also help us understand how this approach can support overall well-being in seniors.

The main questions it aims to answer are:

• Does referral to a social worker reduce feelings of loneliness in older adults with diabetes?
• Does this support improve blood sugar control (A1C)?

Researchers will compare social worker referral to usual diabetes care to see if this approach improves both social well-being and diabetes outcomes.

Participants will:

• Be assigned (like flipping a coin) to either meet with a social worker or continue their usual care
• Complete a short 3-question loneliness survey at the start and again after 6 months
• Have their A1C levels reviewed from their routine medical records

Study Overview

• Status: Active, not recruiting
• Conditions: Diabete Mellitus; Loneliness
• Intervention / Treatment: Other: Continue Primary care; Behavioral: Social worker referral to address loneliness

Detailed Description

This study is a pragmatic, single-centre, parallel-group randomized controlled trial evaluating the integration of social prescribing into primary care for older adults with diabetes who experience loneliness. The intervention is delivered within an academic family health team and leverages existing interprofessional resources to address social determinants of health as part of routine clinical care.

Potential participants will be identified through electronic medical record (EMR) queries and clinic-based outreach. Loneliness screening will be conducted using the three-item UCLA Loneliness Scale (UCLA-3), administered via a secure electronic platform (REDCap). A flexible consent process, including both electronic and verbal options, will be used to accommodate varying levels of digital literacy within the target population.

Following enrolment, participants will be assigned to study arms using simple randomization (coin toss). The intervention consists of a structured referral to a primary care social worker. The social worker will conduct an initial assessment of the participant's social context, including social supports, barriers to engagement, and unmet practical needs. Based on this assessment, a co-developed plan will be implemented, which may include connection to community resources, facilitation of social engagement activities, and support addressing social or logistical barriers. Follow-up will be individualized in frequency and modality (in-person or virtual), reflecting a pragmatic, patient-centred approach.

Intervention delivery will not be protocolized beyond core components, in order to reflect real-world clinical practice. All social worker interactions will be documented within the EMR, allowing for characterization of intervention exposure (e.g., number and type of contacts). Participants in the comparator arm will continue to receive usual diabetes care during the study period, with access to social worker referral after study completion.

Study data will be collected through a combination of participant-reported measures and EMR-derived clinical data. Data will be stored in REDCap using unique study identifiers, with linkage files maintained separately on secure, access-restricted servers. Analyses will use regression-based approaches to estimate between-group differences, adjusting for baseline values and relevant covariates.

This study is designed to evaluate the feasibility and effectiveness of incorporating social care into chronic disease management within primary care settings. Findings will inform the scalability and implementation of social prescribing interventions aimed at reducing loneliness and improving health outcomes among older adults.

• Study Type: Interventional
• Enrollment (Estimated): 90
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M4N 3M5
      • Sunnybrook Health Sciences Centre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Diabetes, lonely

Exclusion Criteria:

• Dementia, acute psychiatric or medical illness

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Continue primary care; Continue seeing primary care provider	Other: Continue Primary care; Continue seeing primary care
Experimental: Intervention arm; Referral to see a social worker	Behavioral: Social worker referral to address loneliness; Patients will be referred to social worker for loneliness management

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hemoglobin A1C (glycated hemoglobin) level	Hemoglobin A1C (glycated hemoglobin) is a routinely used laboratory measure that reflects average blood glucose levels over the preceding 3 months. In this study, A1C values will be obtained from participants' electronic medical records (EMR) as part of routine clinical care; no additional blood draws will be required for research purposes. Baseline A1C will be defined as the most recent value within ±4 weeks of enrolment. Follow-up A1C will be the value obtained closest to 6 months after enrolment, within routine clinical testing intervals. A1C is reported as a percentage (%), with higher values indicating poorer glycemic control. Change in A1C from baseline to 6 months will be used to assess the effect of the intervention on glycemic control. The secondary analysis will adjust for baseline A1C and relevant clinical factors, including medication changes where applicable.	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The University of California, Los Angeles (UCLA - 3) score	The UCLA 3-item Loneliness Scale (UCLA-3) is a validated, brief self-reported measure used to assess subjective feelings of loneliness and social isolation. It consists of three questions that ask participants how often they experience key aspects of loneliness: (1) lacking companionship, (2) feeling left out, and (3) feeling isolated from others. Each item is scored on a 3-point Likert scale: = Hardly ever; = Some of the time; = Often The total score ranges from 3 to 9, with higher scores indicating greater perceived loneliness. In this study, the UCLA-3 is administered at baseline and at 6 months electronically via REDCap. A score of ≥5 is used as the threshold to define clinically relevant loneliness for study eligibility. Change in UCLA-3 score over time is used to assess the effect of the intervention, with a reduction in score indicating improvement in perceived loneliness.	6 months

Collaborators and Investigators

• Sponsor: University of Toronto
• Investigators: Principal Investigator: Rachel Walsh, MD CCFP, Sunnybrook Health Sciences Centre

Publications and helpful links

General Publications

• Ida, S., & Murata, K. (2022). Social Isolation of Older Adults with Diabetes. Gerontology & geriatric medicine, 8, 23337214221116232. https://doi.org/10.1177/23337214221116232
• Cho, E., Kim, J., & Bang, S. (2024). Loneliness in older adults with diabetes mellitus: a scoping review. Psychology, health & medicine, 29(8), 1548-1563. https://doi.org/10.1080/13548506.2023.2299665
• Song, Y., Zhu, C., Shi, B., Song, C., Cui, K., Chang, Z., Gao, G., Jia, L., Fu, R., Dong, Q., Feng, L., Zhu, C., Yin, D., Manson, J. E., & Dou, K. (2023). Social isolation, loneliness, and incident type 2 diabetes mellitus: results from two large prospective cohorts in Europe and East Asia and Mendelian randomization. EClinicalMedicine, 64, 102236. https://doi.org/10.1016/j.eclinm.2023.102236
• Henriksen, R. E., Nilsen, R. M., & Strandberg, R. B. (2023). Loneliness increases the risk of type 2 diabetes: a 20-year follow-up - results from the HUNT study. Diabetologia, 66(1), 82-92.
• Kobos, E., Szewczyk, A., Świątkowska, T., Kryczka, T., & Sienkiewicz, Z. (2020). Relationship between loneliness and blood glucose control in diabetes. BMC public health, 20(1), 1140. https://doi.org/10.1186/s12889-020-09241-z

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2026
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2026

Study Registration Dates

• First Submitted: March 13, 2026
• First Submitted That Met QC Criteria: March 17, 2026
• First Posted (Actual): March 20, 2026

Study Record Updates

• Last Update Posted (Actual): March 25, 2026
• Last Update Submitted That Met QC Criteria: March 20, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Endocrine System Diseases; Metabolic Diseases; Glucose Metabolism Disorders; Nutritional and Metabolic Diseases; Diabetes Mellitus
• Other Study ID Numbers: 6941

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: As per research ethic board policy, only result of the study will be disseminated.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No