Adverse childhood experiences and risk of diabetes: A systematic review and meta-analysis

BACKGROUND: The association between adverse childhood experiences (ACEs) and diabetes is unclear. This systematic review and meta-analysis aims to quantify the association between the number and types of ACEs and diabetes during adulthood based on available observational studies. METHODS: A comprehensive literature search of studies exploring the association between ACEs and diabetes was conducted in PubMed, Medline, and Embase databases until 15 April 2022. A random-effects model was used to pool odds ratios (ORs) and 95% confidence intervals (CIs) for the number and types of ACEs with diabetes. Regarding the association between the number of ACEs and diabetes, we used funnel plots to examine publication bias, subgroup analysis to explore sources of heterogeneity, and sensitivity analysis to explore the robustness of the pooled results. RESULTS: A total of 49 studies were included. Individuals with higher continuous ACEs (per each additional ACE: OR = 1.06, 95% CI = 1.02-1.10), any ACE (OR = 1.22, 95% CI = 1.16-1.28), or ≥4 ACEs (OR = 1.44, 95% CI = 1.27-1.63) were at an increased risk of diabetes in adulthood when compared with individuals without ACEs. Across specific ACE types, childhood economic adversity (OR = 1.11, 95% CI = 1.04-1.19), physical abuse (OR = 1.14, 95% CI = 1.07-1.21), sexual abuse (OR = 1.25, 95% CI = 1.12-1.39), verbal abuse (OR = 1.11, 95% CI = 1.03-1.20), and incarceration (OR = 1.22, 95% CI = 1.03-1.45) were associated with diabetes. However, neglect, emotional abuse, domestic violence, parental divorce or separation, parental death, and living with a family member with substance abuse or mental disorders were not significantly associated with diabetes. CONCLUSIONS: Individuals with ACEs may have a cumulative risk for diabetes in adulthood. It is critical to prevent ACEs and build resilience in individuals affected by ACEs.