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Reply to "Does a history of ACEs correspond with poorly controlled Diabetes?"

Dr Warren,

I disagree, I think this is an easier field in which to conduct "research", at least applied / clinical, than I at first thought after reading your initial request, IF

  • one initially defines what the "problem" is
  • one defines the population(s) in which this problem is occurring
  • one clearly outlines the proposed mechanism(s) thought to give rise to the problem

You at first defined the problem is, or hypothesised that, people with ACEs histories use food to deal with the negative affect residual after surviving a development marked by ACEs. Thus, one needs measures of both ACEs and state of emotional distress, and an ongoing behavioral diary of food intake, including type of food. The question was unclear, however, whether or not the ACEs is thought to have an etiological role in the development of diabetes, or whether such a history is linked to ongoing non-adherence to recommended healthy eating. Surprisingly, the role of obesity in the development of diabetes went unaddressed, yet obesity is also more common in those with ACEs histories. So, what is the problem

  • use of food to cope with negative affect, or
  • non-adherence to recommended healthy eating plans, or some combination of these

Is the population of interest

  • only those with ACEs histories who have diabetes who do not adhere to healthy eating plans, or, more generally,
  • those people with diabetes who do not adhere to healthy eating plan -- you will find many more of the latter than the former, and you will find many people with ACEs histories who have diabetes who DO adhere to recommended eating plans, but who have other dysfunctional coping behaviors; while other people with ACEs histories and diabetes who do not have such problems.

What is the proposed mechanism underlying the problem behavior --

  • some sort of "self-medication", or 
  • something arising from disturbed sense of self specific to some people with ACEs histories?
  • some more general mechanism -- you're likely to find many people with diabetes who do not adhere to recommended healthy eating plans who share this mechanism in common, whether or not they have a history of ACEs

Looked at in these ways one can perform more specific literature searches, not be overwhelmed by all those thousands of results Google Scholar produces, and, lo and behold, find programs already existing in Britain to address some of these issues. As I said, speak to Louise, she can help direct you in some areas, and discuss how issues specific to people with ACEs histories "might" be able to be addressed IF it's necessary, which I suspect it might not be, at least regarding the question of non-adherence to healthy eating plans.

And Veronique, yes, also people with T2DM "can vary significantly from day to day even when they eat the same things and do the same things multiple days in a row", certainly true for me -- person with high ACEs score who's also had T2IDDM (for the non-medicos, Type 2 Insulin-Dependent Diabetes Mellitus) for over 20 years, these things often being stress-related, but usually leading to HYPER- rather than hypoglycemia.

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