Association of Adverse Childhood Experiences with Glycemic Control and Lipids in Children with Type 1 Diabetes

Abstract

Adverse childhood experiences (ACE) have been associated with a greater prevalence of risky behaviors and chronic health conditions, such as diabetes in adulthood. While adolescents with risk taking behaviors experience worsening of diabetic metabolic control, it is yet to be determined whether glycemic management in children and adolescents is negatively and independently influenced by ACEs. This study examines the relationship between ACEs in children and adolescents with type 1 diabetes (T1DM) and glycemic control, BMI and lipids. For such children, we hypothesized that hemoglobin A1c (HbA1c) is positively correlated with ACE scores. Parents of children (age 2–18 years) with T1DM completed a validated ACE questionnaire. The associations between parent and child ACE score and HbA1c, lipids and BMI z-scores were assessed using linear regression. The prevalence of any ACE was 27.9% among children and 49.0% among parents. HbA1c was significantly higher in children who had exposure to three or more ACEs (β:0.63 (4.5 mmol/mol); p = 0.02), in those who had a parent exposed to four or more ACEs (β:0.87 (7.2 mmol/mol); p = 0.03), in children who had exposure to household incarceration (β:0.62 (4.4 mmol/mol); p = 0.05) and children who witnessed or had been victim of violence in the neighborhood (β:0.71 (5.4 mmol/mol); p = 0.02). ACEs were highly prevalent among children with T1DM and had a positive association with glycemic control.

Relationships among adverse childhood experiences, delay discounting, impulsivity, and diabetes self-management.

“…To the authors' knowledge, this is the first study to report this connection, but it is consistent with previous research that demonstrates an association between childhood adversity or trauma with risky health behaviors and decreased adherence to oral medication regimens (e.g., Edwards et al, 2007;Korhonen et al, 2015;Mugavero et al, 2006;Whetten et al, 2013). The current study additionally builds upon recent findings by Iqbal et al (2020) that describe this relationship in youth with T1DM. The reported findings also support the previously established association between ACEs and increased BMI (Rehkopf et al, 2016).…”

“…Likewise, exposure to stressful life events (e.g., being involved in a motor vehicle accident or having a close friend move away) has been found to predict poorer diabetic self-care behaviors, fewer blood glucose meter readings, and higher A1c over time in adolescents with T1DM (Helgeson et al, 2010). Additionally, a recent study by Iqbal et al (2020) suggests that there is a relationship between increased ACE exposure and higher A1c in children and adolescents with T1DM, but the current literature is scant regarding the association between ACEs and self-management of diabetes in patients with T1 and T2DM.…”

Effects of Trauma and Anxiety on Adherence in Pediatric Type 1 Diabetes

“…Although we did not require participants to describe their traumatic experiences, prior work has established that many children with diabetes find the experiences related to their diagnosis traumatic (21). The screening questionnaires we used did ask questions about some experiences that could be considered adverse childhood experiences, including physical and sexual abuse, as well as witnessing family violence; however, the CATS trauma screening tool we used does not specifically ask about emotional abuse or neglect or experiences related to household dysfunction, nor does it calculate a score related to traumatic exposure, which may account for differences between our study and that of Iqbal et al (14). Additionally, we did not examine the timing of traumatic events, which may account for differences from other studies that have examined past-year stressful life events (13,32).…”

“…We also relied on children's reports of traumatic events and their perception of the impact of these impact on their functioning, which may have been limited by recall and subjective interpretation of impairment. Finally, there are some methodological differences in how trauma exposure was defined in our study compared with prior work (14), which may have influenced the reporting and outcomes.…”

Nonsexual violence against children and adolescents: a study in a Latin American tertiary and university hospital

“…Reports involving violence in patients with pediatric chronic diseases followed up in tertiary services were generally restricted to case series of specific pediatric chronic conditions, such as disabilities, 7 human immunodeficiency virus (HIV), 8 , 9 diabetes mellitus, 10 , 11 juvenile idiopathic arthritis, 12 and childhood-onset systemic lupus. 13 …”