How Do Adverse Childhood Experiences Impact Diabetes and Its Complications?

A recent poster presented at the The Symposium on Advanced Wound Care (SAWC) Spring | Wound Healing Society (WHS) co-located with the Diabetic Limb Salvage (DLS) Conference discussed 2 important topics that may not immediately appear to carry relevance to one another.¹Adverse childhood experiences (ACEs) are events occurring before the age of 18 that cause stress or trauma such that there is a resultant harm or potential harm to that person’s health or well-being.² The literature correlates high numbers of these events with conditions such as diabetes, heart disease, autoimmune disorders, obesity, and premature death.^2-6

In their poster, a team of student researchers led by Khurram Khan, DPM, FACFAS, Clinical Associate Professor at Temple University School of Podiatric Medicine, aimed to begin to investigate if this correlation specifically extended to complications of diabetes.¹
Temitope Adebayo, BS, a third-year student at Temple University School of Podiatric Medicine and co-author on the poster, shared that the work of Subramaniam and team found increased odds of both type 1 and type 2 diabetes among children exposed to divorce or death of a parent.²

“They found a correlation between adverse childhood experiences, which included elevation of blood glucose levels,” she added.  

Student Doctor Adebayo also pointed to the work of Hughes and colleagues who found an association between uncontrolled type 2 diabetes in adults using insulin and oral therapy and increased numbers of ACEs in their history.⁵

Sharon Dei-Tumi, MPH, also a third-year podiatric student and co-author of the poster, related that she and her research colleagues asked this question: since there is an association between ACEs and diabetes, is there also a correlation between diabetes-related comorbidities or diabetes outcomes and ACEs?

“(We found) very little research that directly tied diabetic ulcers and amputations to ACEs,” she shared. “But, it could be inferred, because if someone has diabetes and a high number of ACEs, and developed an ulcer or underwent an amputation, that inference could be drawn.”

Student Doctor Adebayo added that their current research focuses on trying to elucidate this relationship more clearly, and also, if quantitatively higher ACE scores relates to the severity of diabetic foot outcomes.

Both authors shared that they are participating in the study under the guidance of Dr. Khan, recruiting patients between the ages of 18 and 85 who meet the inclusion criteria at the Foot and Ankle Institute in Philadelphia.

Student Doctor Dei-Tumi outlined their goals for the next step of the investigation: “Hopefully we will be able to identify that correlation, if it is present, and potentially add to the pool of knowledge on how to help patients with diabetes and who have experienced ACEs so they don’t just become another statistic.”

Editor’s Note: For a video interview with the student authors, click here.

References

1.    Adebayo T, Dei-Tumi S, Khan K. Correlation between adverse childhood experiences and the development of poor diabetic outcomes. Poster presented at SAWC Spring, April 27-30, 2023; National Harbor, MD.
2.    Subramaniam M, Abdin E, Seow E, et al. Prevalence, socio-demographic correlates and associations of adverse childhood experiences with mental illnesses: Results from the Singapore Mental Health Study. Child Abuse Negl. 2020;103:104447. doi: 10.1016/j.chiabu.2020.104447.
3.    Chu WWE, Chu NF. Adverse childhood experiences and development of obesity and diabetes in adulthood – A mini review. Obes Res Clin Pract. 2021;15(2):101-105
4.    Huffhines L, Noser A, Patton SR. The link between adverse childhood experiences and diabetes. Curr Diab Rep. 2016;16(6):1-9
5.    Hughes K, Ford K, Bellis M. Adverse Childhood Experiences (ACEs) and Diabetes. A brief review. Public Health Wales; Bangor University. 2020. Available at: https://research.bangor.ac.uk/portal/files/37959822/PHWBangor_ACEs_Diabetes_Factsheet_5_.pdf . Accessed April 30, 2023.
6.    Pemayun TGD, Naibaho RM, Novitasari D, Amin N, Minuljo TT. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case–control study. Diabet Foot Ankle. 2015;6(1):29629