Adverse Childhood Experiences and Diabetes Complications: What Do We Know?

Sharon Dei-Tumi, MPH, MS3:

I'm Sharon Dei-Tumi, and I am a third-year podiatric medical student at Temple. I have my Master's in public health from Drexel University.

Temitope Adebayo, MS3:

Hello. My name is Temitope Adebayo. I am a third-year podiatric medical student from Temple University School of Podiatric Medicine, and I have a Bachelor's degree from the University of Maryland Baltimore County.

So far what we know is that there is in fact a correlation between adverse childhood experiences and diabetes. The original study was done by Kaiser and the CDC in 1997, and what they found was that there is a correlation between adverse childhood experiences and the development of chronic illnesses like diabetes, heart diseases and autoimmune diseases as well.

And then subsequent research all focused on adverse childhood experiences and diabetes. And what they found was that there is an increased odds risk of type one and type two diabetes amongst children that were exposed to a divorce or death of a parent. They found a correlation between adverse childhood experiences and hormonal changes, which included elevation of blood glucose levels.

Another research done by Hughes et al also found that, in adults, what they reported was an association between uncontrolled type two diabetes in adults who take insulin and oral medication therapy. And they did find that they had increased adverse childhood experiences with a score between two to six indicating about two to six different adverse childhood experiences. So we do know that there is a correlation between adverse childhood experiences and diabetes.

Sharon Dei-Tumi, MPH, MS3:

Well, our primary goals were to establish that since there is an association between ACEs and diabetes, is there also a correlation between diabetic-related comorbidities or diabetic outcomes such as ulcers and resulting amputations and ACEs? Is there a standalone correlation with ACEs? So that was the goal of our literature review.

And it was interesting because, like Temi mentioned, we did rehash the existing associations, but there was very little research that directly tied diabetic ulcers and amputations to ACEs. But then it's like the literature, it could be inferred because if someone has diabetes and they developed an ulcer and then they had an amputation. And they did indicate that they had some form of ACEs, that inference could be drawn. But unfortunately there was a dearth in that literature or that research. But there is a dearth in research in that area.

Temitope Adebayo, MS3:

Future directions would be to determine if there is a correlation between adverse childhood experiences and the development of diabetic foot ulcers and non-traumatic amputations. Like Sharon just said, we can infer that because you would expect negative diabetic foot outcomes if there is a correlation with diabetes that has been established. Also to determine if the higher the score, meaning the higher number of experiences that a child is exposed to, if that equates to the severity of the diabetic foot outcome.

Also, I think it will also be interesting to find out if the severity of the experience itself has something to do with the severity of the outcome as well. I think if people are aware that there is in fact an effect of adverse childhood experiences, I think this is going to reduce the prevalence of chronic illnesses that we have today. And also the delivery of healthcare I think will be impacted in a good way.

Sharon Dei-Tumi, MPH, MS3

I definitely agree, and that's actually also what brought us to this research project. And so with what we're doing right now, we're actually under the guidance of one of our clinicians, Dr. Khan. We are conducting a study where we recruit patients who come to our clinic at the Foot and Ankle Institute. And patients are consented and given information about what the research study is because we are doing what Temi described, trying to identify that association, or the lack thereof, and also assessing the severity.

And our selection criteria is between of ages of 18 to 85 and everyone who is interested and fits the other inclusion methods are going to be enrolled. And 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 who are diabetic and who have experienced ACEs so they don't just become another statistic.