Abstract
Objective: Adverse childhood events (ACEs) have significant impacts on adulthood health, including greater risk of Type 2 diabetes (T2D). While there is a known connection to increased use of outpatient and emergency healthcare services, the potential role of ACEs in routine diabetes care utilization remains unclear. This study uses ACE subtypes to explain pathways to routine diabetes care utilization among adults with T2D. Method: Cross-sectional data were obtained from the 2019 Behavioral Risk Factor Surveillance System, a survey of a representative sample of U.S. adults. Eligible participants resided in a state that completed both the Adverse Childhood Experiences (ACEs) and Diabetes modules and were diagnosed with non-gestational diabetes (N = 9,904), of whom the majority were presumed to have T2D. Confirmatory factor analysis was used to test the measurement model for three ACE factors: household dysfunction, physical and emotional abuse, and sexual abuse. Structural equation modeling was used to relate factors to four routine diabetes care utilization outcomes. Results: Factor loadings were strong, and fit indices indicated good measurement model and full structural model fits. In the full structural equation model, household dysfunction was associated with decreased likelihood of meeting frequency recommendations for A1C testing (β = −0.22, p < .05) and foot exams (β = −0.29, p < .01). Physical and emotional abuse were associated with greater likelihood of meeting A1C testing frequency recommendations (β = 0.21, p < .05). Conclusion: Specific types of ACEs may differentially relate to routine diabetes care utilization in adulthood.
Impact Statement
Adverse childhood experience types related differently to whether recommendations for four different types of routine diabetes care were met among U.S. adults with type 2 diabetes (T2D). Specifically, people with a history of childhood household dysfunction were less likely to meet ADA recommendations for A1C testing and foot exams from a medical provider. Findings highlight the potential significance of trauma-informed diabetes care to address disparities in diabetes self-management and engagement with routine diabetes care. However, future studies should discover why and how adverse childhood experiences relate to routine diabetes care use in adulthood to further optimize intervention strategies.
Hoadley, A., Bass, S., & Rubin, D. J. (2023). Adverse childhood event subtypes and routine diabetes care utilization among U.S. adults with Type 2 diabetes. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0001433