October 18, 2018
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Adverse childhood experiences increase prediabetes markers in adulthood

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Adults who reported adverse childhood experiences are at greater risk for developing higher BMI, waist circumference, insulin resistance and other prediabetes indicators vs. those without adverse childhood experiences, according to findings published in the Journal of Diabetes and its Complications.

“Well documented as being predictors of adult morbidity and mortality, a single endorsement of an [adverse childhood experience] significantly increases risk for diabetes in adulthood, with risk increasing as number of reported [adverse childhood experiences] increases,” Jennifer A. Campbell, MPH, of the department of medicine at the Medical College of Wisconsin, and colleagues wrote. “Prediabetes is a widely unexplored area in the literature for understanding the impact of [adverse childhood experiences] on diabetes and may be an important area of emphasis for intervention in individuals exposed to [adverse childhood experiences]. ... Given the growing focus on trauma-informed care, new information is needed to structure screening and treatment for individuals who experience [adverse childhood experiences].”

Campbell and colleagues conducted a two-wave, longitudinal study that included phone interview and questionnaire data from 1,054 participants (mean age, 55 years; 54.7% women; 93.07% white) collected between 1995-1996. Researchers measured BMI, waist circumference, waist-to-hip ratio, systolic and diastolic blood pressure, blood fasting glucose, blood fasting insulin, insulin resistance and HbA1c in participants between 2002 and 2004.

Self-reported adverse childhood experiences were stratified by six categories: emotional abuse, physical abuse, sexual abuse, parental substance abuse, family instability and financial strain.

Within the cohort, 718 adults reported at least one adverse childhood experience. Among those, researchers found that mean BMI was higher vs. adults who did not report an adverse childhood experience (mean, 29.57 kg/m² vs. 28.33 kg/m²; P = .0017), as was the rate for obesity (35.38% vs. 28.06%). In addition, the researchers noted that 56.82% of the participants who experienced an adverse childhood experience had a waist circumference deemed very high vs. 47.16% for all other participants.

Mean fasting insulin levels were higher for the participants with at least on adverse childhood experience vs. other participants (13.57 µIU/mL vs. 11.09 µIU/mL; P = .0025). High-risk insulin levels were reported in 11.28% of participants who had adverse childhood experiences compared with 6.97% of all other participants, according to the researchers.

When researchers looked at categories of adverse childhood experiences, they found that physical abuse led to increases in waist circumference (beta = 2.78; 95% CI, 0.04-5.52) and fasting insulin levels (beta = 2.52; 95% CI, 0.25-4.79). BMI was also elevated for those who reported sexual abuse (beta = 1.06; 95% CI, 0-2.12) or financial strain during childhood (beta = 0.97; 95% CI, 0.15-1.79).

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“The current results suggest that the association of [adverse childhood experiences] with BMI and insulin resistance are not independent of each other, but rather represent important factors within the pathway between [adverse childhood experiences] and prediabetes in adulthood,” the researchers wrote. “In addition to its association with obesity, chronic exposure to psychosocial stressors has been associated with increased corticotropin-releasing factor (CRH) levels, consistent with chronic activation of the HPA axis known to cause elevated cortisol levels and, therefore, increased insulin resistance.”

Multiple occurrences of childhood abuse were more likely to increase prediabetes indicators in the study population. BMI (beta = 1.88; 95% CI, 0.5-3.26), waist circumference (beta = 3.86; 95% CI, 0.32-7.39), blood fasting insulin levels (beta = 4.13; 95% CI, 1.23-7.04) and insulin resistance (beta = 1.17; 95% CI 0.31-2.03) all increased for those who reported at least four adverse childhood experiences.

“Recognizing that [adverse childhood experience] score and exposure may accelerate the diagnosis of prediabetes, screening tools would enable providers to tailor treatment plans to suit patients' needs and minimize risk,” the researchers wrote. “In addition, recognizing that specific types of [adverse childhood experiences] may have a differential effect on outcomes is important for designing and implementing screening.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosure. The National Institute of Diabetes and Digestive and Kidney Diseases supported this study.