Does a history of ACEs correspond with poorly controlled Diabetes?

Dear Colleagues,

I am working with a group of primary care doctors in England who specialise in Diabetes management. We have a hypothesis that emotional distress associated with higher ACE scores will lead to poorly controlled diabetes due to the use of food as a way of coping with emotional distress.

Has anyone got any advice, experience they can share or can anyone point me towards academic papers that explore this theme?

Many thanks and best wishes

Dr Warren Larkin

Original Post

Fascinating, dreadfully important question ;-D

Not easy to address: "Do people self-medicate their emotional distress resulting from ACEs using food?"  Deceptively simple, but ..

Guess you're familiar with the general literature on self-medication (I remember a number of studies just addressing use of opiates as emotional self-medication in the journal Addiction a few years ago)?

Sfaik the conclusion is that there're so many different factors that must be considered for any one factor to be "the" factor; and you'd also be aware that if one does a google scholar search using "diabetes etiology coping "adverse childhood experiences"" one comes up with over 500 citations to evaluate -- just published since 2017. So, you're asking if anyone's been lucky enough to come up with the handful of studies that have shown ACEs to be overwhelmingly significant in demonstrating that  poor self-care through poor dietary control results in diabetes -- "sensible conclusion" (so long as poor dietary control in and of itself produces diabetes???  I know a lot of people with diabetes would challenge that).

Well, I'm sorry, but the only work I know of is reviewed in the attached paper (mentioning Tamayo, 2010),  but the topic is fascinating and I've marked it to follow -- please let me know what other material you find --- I wish you every bit of luck, not an easy topic to research :-D

fwiw you might find some other articles of interest on this list,

https://www.ncbi.nlm.nih.gov/p...mp;from_uid=20809937

Attachments

Paul Metz posted:

Fascinating, dreadfully important question ;-D

Not easy to address: "Do people self-medicate their emotional distress resulting from ACEs using food?"  Deceptively simple, but ..

Guess you're familiar with the general literature on self-medication (I remember a number of studies just addressing use of opiates as emotional self-medication in the journal Addiction a few years ago)?

Sfaik the conclusion is that there're so many different factors that must be considered for any one factor to be "the" factor; and you'd also be aware that if one does a google scholar search using "diabetes etiology coping "adverse childhood experiences"" one comes up with over 500 citations to evaluate -- just published since 2017. So, you're asking if anyone's been lucky enough to come up with the handful of studies that have shown ACEs to be overwhelmingly significant in demonstrating that  poor self-care through poor dietary control results in diabetes -- "sensible conclusion" (so long as poor dietary control in and of itself produces diabetes???  I know a lot of people with diabetes would challenge that).

Well, I'm sorry, but the only work I know of is reviewed in the attached paper (mentioning Tamayo, 2010),  but the topic is fascinating and I've marked it to follow -- please let me know what other material you find --- I wish you every bit of luck, not an easy topic to research :-D

fwiw you might find some other articles of interest on this list,

https://www.ncbi.nlm.nih.gov/p...mp;from_uid=20809937

Thanks Paul. I appreciate your support and thoughts on this. Not a simple area to get to the bottom of as you acknowledge. I will let you know if I find anything noteworthy. Best wishes. Warren 

Esther Gilbert posted:

I know you’re correct. I’d like to hear what you find. I worked in geropsych home care as a Clinical Social Worker. I wished that we had taken stock of what we’d found. I wonder whether my old supervisor and the agency would permit research like this. I will ask.

Many thanks Esther!

Dr Warren Larkin posted:
Paul Metz posted:

Fascinating, dreadfully important question ;-D

Not easy to address: "Do people self-medicate their emotional distress resulting from ACEs using food?"  Deceptively simple, but ..

Guess you're familiar with the general literature on self-medication (I remember a number of studies just addressing use of opiates as emotional self-medication in the journal Addiction a few years ago)?

Sfaik the conclusion is that there're so many different factors that must be considered for any one factor to be "the" factor; and you'd also be aware that if one does a google scholar search using "diabetes etiology coping "adverse childhood experiences"" one comes up with over 500 citations to evaluate -- just published since 2017. So, you're asking if anyone's been lucky enough to come up with the handful of studies that have shown ACEs to be overwhelmingly significant in demonstrating that  poor self-care through poor dietary control results in diabetes -- "sensible conclusion" (so long as poor dietary control in and of itself produces diabetes???  I know a lot of people with diabetes would challenge that).

Well, I'm sorry, but the only work I know of is reviewed in the attached paper (mentioning Tamayo, 2010),  but the topic is fascinating and I've marked it to follow -- please let me know what other material you find --- I wish you every bit of luck, not an easy topic to research :-D

fwiw you might find some other articles of interest on this list,

https://www.ncbi.nlm.nih.gov/p...mp;from_uid=20809937

Thanks Paul. I appreciate your support and thoughts on this. Not a simple area to get to the bottom of as you acknowledge. I will let you know if I find anything noteworthy. Best wishes. Warren 

Perhaps you're merely "visiting" the wrong university.

Why don't you speak to Louise from University College Dublin, I'm sure together you'll easily find some British resources to address this issue, but you'll need to get some practice-based research established to get the empirical evidence to go further with it.

Dear Warren,

I’m a family doctor who retrained as a somatic psychotherapist specializing in trauma and chronic illness. I’ve been looking at the research linking trauma to many kinds of chronic illnesses with a special interest in type I diabetes and some findings in type 2 diabetes along the way.

I haven’t focused a lot on diet but have been curious about the role of stress and trauma triggers in relation to blood sugar levels and long term complications.

While disordered eating is certainly one effect of trauma, I suspect it is only one of many factors that influence risk for diabetes, blood sugar levels and long-term complications.

I’ve heard from some type one diabetics over the years that their blood sugar levels can vary significantly from day to day even when they eat the same things and do the same things multiple days in a row. I don’t know if this is also true in type 2 diabetes.

One of my theories is that both type 1 and type 2 diabetes reflect states of disordered metabolic physiology and that blood sugar levels (and variability as well as ease of control) are unique to each individual’s history and therefore triggers, just as stressors that trigger symptoms of PTSD are unique to each individual. Some studies support this (see attached).

I’ve also wondered if a younger age of onset reflects greater exposure to stressors / trauma and whether complications in general might be greater in those with a history of more adversity. I've included a few references on this topic as well. 

Depression is twice as common in diabetes 1 and 2 (see Holt, below), affecting 1 in 4. QOL is worse, complications are increased, life expectancy reduced. There is a higher risk of diabetes with depression and depression effects are long lasting & recurrent. This may be one effect of trauma that influences eating habits in diabetes as well as in those who do not have the illness.

Attached are a few studies that might be of interest, even though they don’t address diet and eating habits.

Dahlquist, 1991: stress in year before diagnosis is the only factor affecting age of onset

Gonder-Frederick study indicated that IDDM subjects' BG response to an active stressor was idiosyncratic but significantly reliable over time.

Holt: overview of Depression in diabetes

Riazi (a book chapter from 2000): blood sugar levels appear to be idiosyncratic with some individuals having hyperglycemia, others hypoglycemia and some with no response to similar stressors. They also cite a 1950s study by Hinkle (see attached) showing that all individuals have changes in glucose levels in response to stress. The response is just higher in diabetes (p 690)

Yehuda 2015 cites a study (see attached, Yehuda 2009) showing that “there are different responses in glucose use following glucocorticoid injection in those with PTSD compared with unaffected individuals”.

Attachments

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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Veronique MeadTracy Glaser-BaconCarey S. SippPaul Metz
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