How do adverse childhood experiences (ACE) influence self-management and control of type-2 diabetes in later life?

Abstract

Research indicates that ACEs are common and adults who have experienced abuse, neglect, or household dysfunction are at higher risk for emotional, mental, and physical health problems, such as type-2 diabetes. However, little is known about how adults with type-2 diabetes and ACEs self-manage their diabetes. The delayed time between exposure to ACEs and the diagnosis of diabetes can inhibit recognition of the relationship between the two. Identifying ACEs in adults and treatment of diabetes share similar goals: to improve health outcomes and quality of life. Self-management of type-2 diabetes can be stringent and challenging, requiring collaborative work between patients and healthcare providers.

The purpose of this study was to explore the adults’ perception of how ACEs influence how they self-manage and control their type-2 diabetes. This qualitative multiple case study took place at two healthcare practices at the Institute for Family Health, which serves Hispanic/Latino and Black, low socioeconomic communities. One-on-one semi-structured interviews were the primary means of data collection. A diabetes self-management survey (SDSCA) and collection of hemoglobin A1C levels were utilized to provide triangulation.

The findings revealed that all participants described multiple ACEs and spoke of emotional neglect. Physical neglect and abuse, and separation from family member(s) were also prevalent. Most often these experiences evoked feeling helpless, unloved, and depressed. Overall, this group of adults self-managed their diabetes poorly, as evidenced by their responses to the interview, SDSCA, and A1C levels. Finally, they denied the influence of ACEs on how they self-managed their diabetes.

This study found that ACEs elicit physical and emotional effects that may influence how adults with type-2 diabetes self-manage their diabetes. Denial of a connection between the two may contribute to poor self-management. Further analysis determined that participants fell into one of three groups: (1) the Proactives, a small group, who despite their ACEs were actively involved in self-management; (2) the Deniers, who denied the severity of their ACEs and diabetes and didn’t adequately participate in their care; and (3) the Debilitated, who appeared depressed and incapable of participating in self-management. The influence of racial/ethnic, low education, and low SES cannot be underestimated.