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Biomarkers for Diabetes May Differ Based on Childhood Experiences

Dec 1, 2018
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Arsalan Hashmi, PharmD. Candidate, LECOM College of Pharmacy

MIDUS study looks at individual adverse childhood experiences and their impacts on future diabetes.

An adverse childhood experience (ACE) is any experience that produces long-lasting stress in a child’s life and leads to worse overall health, both psychological and physical as an adult. Research has shown that even a single ACE increases the risk of diabetes, but little is known about the mechanism behind this phenomenon or how to prevent its occurrence. Currently the CDC only recommends general programs and support networks to prevent ACEs and there is no guideline for treating patients with ACEs who are at risk to develop diabetes. Previous studies show that patients with ACEs have greater insulin sensitivity but individual ACEs were not specified. There is a need to screen and treat these patients based on “trauma informed care.” This study examined the individual impact of six different ACEs on the development of diabetes.

Data was collected from the study Midlife in the United States: A National Longitudinal Study of Health and Well-Being (MIDUS) at two different points in time. The first round consisted of surveys about the patient’s demographics, personality traits, and behaviors of 7,108 participants. The ACE study questionnaire was designed to discreetly detect adverse childhood experiences including; emotional abuse, physical abuse, sexual abuse, family instability, and financial strain. The second round took place six years later and consisted of 1,054 participants; this was the cohort for this study. This group spent 24 hours in the clinical research center. Fasting blood samples and urinalysis were obtained after an overnight stay. An extensive list of biological measures were also taken, including BMI, A1C, and fasting blood glucose. Multi-variant general linear regression models determined the association between the ACE and variables measured.

Of the 1,054 participants, 68% reported at least one ACE. Across the board there was a statistically significant increase in all biomarkers. Specifically, BMI/waist circumference and insulin levels held more weight and other biomarkers. The study also suggests that insulin resistance may be the connection between increased BMI and ACE, since BMI becomes insignificant when tested on its own. Averages are given below.

 

NO Adverse Childhood Experience Adverse Childhood Experience
BMI 28.33+/-5.36 29.57+/-6.26
Obesity 28% 35.4%
Very High Waist Circumference 47.16% 56.82%
Mean blood fasting insulin 11.09 13.57
HOMA-IR insulin resistance 2.92 3.52

This study further looked at the type of adverse experience and changes in specific biomarkers.

ADE Biomarker Increase
Physical abuse Waist circumference, blood fasting insulin
Sexual abuse BMI
Financial Strain BMI, Fasting Blood Glucose, Blood Fasting Insulin and HOMA-IR Insulin Resistance

This study has shown that the three main biomarkers appear as a result of adverse childhood experiences: increased BMI, waist circumference, and insulin resistance.

Both BMI and insulin resistance are covariates in developing prediabetes after an ACE, and are not independent of one another. Despite the findings of this study, clinicians are not implementing screening tests to identify and treat for ACEs. Recent studies have shown that asking sensitive screening questions relating to ACEs in the clinical setting is acceptable for patients. Studies also found that patients suffering from chronic illnesses had an ACE score of more than 4. With these simple tools, clinicians can intervene in a patient’s progression to diabetes and minimize risk. Clinicians can build a health risk profile for each patient from which they can design an individual treatment plan for each patient.

There are still many unanswered questions. It is unknown if there is a difference between the diabetes of individuals who have and who have not experienced ACEs, and if they should be treated differently.  More research should be done so clinicians can treat based on evidence-based medicine. This study did have limitations. It was done in a largely Caucasian population and may not be generalizable. The study only looked at six categories of ACEs, but there are a vast number of ACEs that could lead to diabetes or other chronic illnesses.

Practice Pearls:

  • Prescribers can use ACE surveys at patient visits to determine if a patient has been exposed to an adverse childhood experience.
  • This study shows that different types of ACEs will trigger different diabetes biomarkers, which the health care professionals can monitor and take action on.
  • This is a relatively new area of study, so there are many questions still to be researched. At the moment, there is no further plan of action for health care professionals to follow.

References:

CDC. “Violence Prevention.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 1 Apr. 2016, www.cdc.gov/violenceprevention/acestudy/about_ace.html.

Campbell, J.a., et al. “The Differential Impact of Adverse Childhood Experiences in the Development of Pre-Diabetes in a Longitudinal Cohort of US Adults.” Journal of Diabetes and Its Complications, vol. 32, no. 11, 2018, pp. 1018–1024., doi:10.1016/j.jdiacomp.2018.09.006.

Arsalan Hashmi, Pharm. D. Candidate 2019, LECOM School of Pharmacy