Adverse childhood experiences and prevalence of type 2 diabetes in a nationwide study of women.

Abstract

We aimed to examine the association between adverse childhood experiences (ACEs) and type 2 diabetes in a nationwide cohort of Icelandic women, and to assess the mechanisms through which it is mediated. We used cross-sectional data from the nationwide-representative Stress-And-Gene-Analysis cohort, including 26 952 Icelandic women aged 18-69 years who self-reported exposure to 13 types of ACEs and adult diagnosis of type 2 diabetes. Modified Poisson regression was used to quantify the association between ACEs and type 2 diabetes, adjusting for age and childhood deprivation. We used causal mediation analysis to test whether adult body mass index (BMI), smoking, and socioeconomic factors mediated the association. Among a sample with a mean age of 44.2 (13.6), 780 (2.9%) women reported a diagnosis of type 2 diabetes. We observed a dose-response relationship between the number of ACEs and type 2 diabetes, of which women with five or more ACEs had almost double the prevalence compared to those with no ACEs (2.0% vs. 3.9%; prevalence ratio 1.90 [1.50-2.42]). Mediation analysis suggested adult BMI, smoking, and socioeconomic factors collectively explained 35.3% (16.5-53.6%) of the association but ACEs remained directly associated with type 2 diabetes (natural direct effect odds ratio 1.64 [1.25-2.26]). Bullying and sexual abuse were independently associated with a higher prevalence of type 2 diabetes. These findings suggest that adverse childhood experiences are associated with type 2 diabetes in adult women, partially mediated through adult BMI, smoking, and socioeconomic factors.