Leonard E. Egede
Childhood trauma, including sexual, physical and verbal abuse, raises the risk for developing type 2 diabetes in adulthood by as much as 57%, according to an analysis published in the Journal of Diabetes and Its Complications.
Since the development of the adverse childhood experience scale, multiple studies have demonstrated that childhood incidence of physical, emotional or sexual abuse, as well as neglect or parental absence, are strong risk factors for poor health outcomes throughout the life span, Jennifer A. Campbell, MPH, of the department of health science at California State University in Long Branch, and colleagues wrote in the study background. In addition to a dose-response relationship between adverse childhood experiences and type 2 diabetes risk, the type of adverse experience has been implicated in risk for diabetes, researchers noted, and sex may also be an important factor.
“Adverse childhood experiences are critical factors to take into account for diabetes prevention and care,” Leonard E. Egede, MD, MS, of the department of medicine at the Medical College of Wisconsin in Milwaukee, told Endocrine Today. “Sexual abuse, in particular, was the strongest predictor of increased odds of diabetes, with individuals reporting sexual abuse having a 57% higher likelihood of diabetes compared to those who did not report sexual abuse. In addition, the odds of diabetes were higher for individuals who experienced verbal abuse, physical abuse, and having a parent with mental illness, and relationships did not differ by gender.”
Campbell and colleagues analyzed data from 48,526 adults who completed the adverse childhood experiences module of the 2011 Behavioral Risk Factor Surveillance System (BRFSS) survey across five states: Minnesota, Montana, Vermont, Washington and Wisconsin. The module is an 11-item survey inquiring about sexual, verbal and physical abuse, and/or family dysfunction during childhood. The items were used to create eight categories of adverse childhood experiences: sexual abuse, physical abuse, verbal abuse, mental illness, substance abuse, incarceration, separation/divorce and violence. Diabetes status was self-reported. Researchers used logistic regression analysis to examine the odds of diabetes in adulthood related to each of the eight individual categories of adverse childhood experiences. A gender interaction term was included to test whether this relationship varied between men and women.
Most participants were aged 35 to 54 years; 83% were white and 33% had some college education. Within the cohort, 34% of participants with diabetes reported experiencing verbal abuse, 30% reported living with an adult or parent who abused substances, and 21% of participants with diabetes reported parental separation or divorce.
After adjusting for age, race, sex, marital status, education level, region and income, those who reported experiencing sexual abuse during childhood saw the greatest increased risk for type 2 diabetes (OR = 1.57; 95% CI, 1.24-1.99), followed by those experiencing verbal abuse in childhood (OR = 1.29; 95% CI, 1.12-1.48) and physical abuse (OR = 1.26; 95% CI, 1.04-1.52). Participants reporting a parent with a mental illness saw a 19% increased risk for diabetes (OR = 1.19; 95% CI, 0.99-1.42). The relationship between individual adverse childhood experience categories and odds of diabetes did not differ by age or sex, according to researchers.
“Adverse childhood experiences resulting in direct physical or emotional violation, for example, sexual abuse and physical abuse, may generate a unique stress response that may predispose an individual for risk of diabetes, compared to other adverse childhood experience categories that may indirectly violate and threaten, such as witnessing verbal or physical abuse or household dysfunction,” Egede said. “Screening for these exposures in clinic and educating care teams about the impact of adverse childhood experiences on the development of diabetes are important strategies to consider to improve long term care and diabetes outcomes.” – by Regina Schaffer
For more information:
, MD, MS, can be reached at Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, 9701 Watertown Plank Rd, Milwaukee, WI 53226 USA; email: firstname.lastname@example.org.
Disclosures: The authors report no relevant financial disclosures.