Overview of adverse childhood experiences with the age of diabetes diagnosis: Examination of the 2021 BRFSS.

Background: Previous research has linked the manifestation of multiple chronic diseases that are frequently due to health behaviors to adverse childhood experiences (ACEs). Despite this, the link between ACEs and the age of diabetes mellitus (DM) diagnosis is scarce. As such, our primary objective was to evaluate and describe the impact of ACEs on the age at diagnosis utilizing the data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS). Our secondary objective was to analyze the relationship between various demographic factors and the Type II DM diagnosis age.

Methods: We conducted a cross-sectional analysis of data from the 2021 cycle of BRFSS. Applying sampling weights, provided by BRFSS, we assessed prevalence rates of ACEs across sociodemographic variables and utilized binary and multivariable regressions to determine associations between sociodemographic factors and ACE scores on age of Type II DM diagnosis.

Results: Among the 437,708 respondents, 57,616 (12.59%) individuals reported having diabetes with 6,901 including responses for age of DM diagnosis and ACEs. We found a dose-response relationship between ACEs and earlier age of diabetes diagnosis—with individuals experiencing 1-3 ACEs being diagnosed 2.15 years earlier (SE=0.48, P<.001) than those with 0 ACEs, and 6.37 years earlier for individuals experiencing 4+ ACEs (SE=0.61, P<.001 ). Significant differences in ACEs and age of diagnosis were also found between ethnoracial groups—compared to White, non-Hispanic individuals with 0 ACEs the mean age of diagnosis was more than 12 years earlier among those who experienced 4+ ACEs and were either Asian, American Indian/Alaskan Native, or Hispanic.

Conclusion: Our study showed that diagnosis of Type II DM among adults who experienced childhood adversity occurred at a much earlier age than those without ACEs. While early diagnosis is critical in long-term DM management, appropriate identification of childhood adversity may be a key component to the development of the disease. This may be achieved through comprehensive child and family resources that target mental health and behavioral factors already known to be associated with DM.