The Link Between Adverse Childhood Experiences and Diabetes
- 838 Downloads
Exposure to adversity in childhood (adverse childhood experiences [ACEs]) is linked to a number of chronic diseases in adulthood, yet there is limited research examining the impact of ACEs on diabetes. The current review sought to examine the association between ACEs, other trauma exposure or posttraumatic stress disorder (PTSD) diagnosis, and risk for diabetes. Thirty-eight studies are reviewed. Unlike in other diseases, several studies in diabetes show a threshold-response versus a dose-response relation, while other studies show a relation between greater abuse severity and diabetes risk. There were mixed results for studies examining abuse type and frequency. Chronic or comorbid PTSD was also related to increased diabetes risk among veterans, but in community samples, only trauma exposure predicted diabetes risk. While the research is still limited, diabetes researchers and clinicians should consider screening for ACEs and examine severity and frequency across abuse type as a predictor of both diabetes and poor diabetes outcomes.
KeywordsAdverse childhood experiences Maltreatment PTSD Diabetes
Compliance with Ethical Standards
Conflict of Interest
Lindsay Huffhines, Amy Noser, and Susana R. Patton declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 7.US Department of Health and Family Services. Child maltreatment. 2012; retrieved from http://www.acf.hhs.gov/sites/default/files/cb/cm2012.pdf.
- 13.••Bellis MA, Hughes K, Leckenby N, Hardcastle KA, Perkins C, Lowey H. Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey. Journal of public health. 2014; 1–10. This paper has an important impact because it demonstrated a threshold effect for ACES and diabetes; the odds of diabetes were higher with at least 4 ACEs, and there was no dose-response relation. Google Scholar
- 16.•Gilbert LK, Breiding MJ, Merrick MT, Thompson WW, Ford DC, Dhingra SS, et al. Childhood adversity and adult chronic disease: an update from ten states and the District of Columbia. Am J Prev Med. 2015;48(3):345–9. This paper is of importance because it demonstrated that 1–3 or 4–6 ACEs, but not 7–9 ACEs, increased the odds of diabetes, which is contrary to previous ACE studies. CrossRefPubMedGoogle Scholar
- 17.••Husarewycz MN, El-Gabalawy R, Logsetty S, Sareen J. The association between number and type of traumatic life experiences and physical conditions in a nationally representative sample. Gen Hosp Psychiatry. 2014;36(1):26–32. This paper is important given that it was one of the few that adjusted for numerous covariates, included a large number of adverse events, and found that both adversity type and exposure to cumulative events resulted in greater odds of diabetes. CrossRefPubMedGoogle Scholar
- 20.•Lynch L, Waite R, Davey MP. Adverse childhood experiences and diabetes in adulthood: support for a collaborative approach to primary care. Contemp Fam Ther. 2013;35(4):639–55. This paper was significant for the field given that it was one of the first to establish a relation between ACEs and T2DM. Specifically, with every 1 point increase in ACE score, patients had 11% greater likelihood of T2DM. CrossRefGoogle Scholar
- 34.•Duncan AE, Auslander WF, Bucholz KK, et al. Relationship between abuse and neglect in childhood and diabetes in adulthood: differential effects by sex, National Longitudinal Study of Adolescent Health. Prev Chron Dis. 2015;12(E70):1–14. This paper was important in providing evidence for a threshold effect, given that greater odds of diabetes were only evident for men who were sexually abused three or more times. Google Scholar
- 41.Boyko EJ, Seelig AD, Jacobson IG, Hooper TI, Smith B, Smith TC. Millennium Cohort Study Team. Sleep Characteristics, Mental Health, and Diabetes Risk A prospective study of US military service members in the Millennium Cohort Study. Diabetes Care. 2013;36(10):3154–61.CrossRefPubMedPubMedCentralGoogle Scholar
- 50.Pietrzak RH, Goldstein RB, Southwick SM, Grant BF. Medical comorbidity of full and partial posttraumatic stress disorder in United States adults: results from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosom Med. 2011;73(8):697–707.CrossRefPubMedPubMedCentralGoogle Scholar