Childhood maltreatment and the risk of impaired glucose metabolism or type 2 diabetes in young adults: findings from the Lifelines Cohort Study

Background: This study examined the associations between childhood maltreatment and the risk of developing impaired glucose metabolism (IGM) or type 2 diabetes in young adults aged 18 to 35.
Methods: Participants (N = 8,506) from the Lifelines Cohort Study without IGM or diabetes at baseline (2007 to 2013) were included. Self-reported childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ), with a total score and subscale continuous scores (ranging from 5-25) for emotional neglect, physical neglect, emotional abuse, physical abuse, and sexual abuse. Incident IGM/type 2 diabetes status (IGM/T2D) was assessed by hemoglobin A1c levels (>5.7%) during a follow-up laboratory visit (2014-2017). 
Results: There were 219 (2.6%) cases of IGM and 4 (0.05%) cases of T2D during the follow-up period. The CTQ total score and sexual abuse subscale were associated with an increased risk of IGM/T2D in unadjusted analyses (RR= 1.03 [95% CI = 1.00, 1.03], p = 0.009 and RR= 1.07 [95% CI = 1.02, 1.12], p = 0.007, respectively). After adjusting for sociodemographic and health/lifestyle covariates and follow-up time, only childhood sexual abuse remained significantly associated with IGM/T2D (RR = 1.05 [96% CI = 1.01, 1.10], p = 0.024). The association remained when additionally accounting for depression and anxiety covariates (RR = 1.05 [96% CI = 1.00, 1.09], p = 0.042). 
Conclusions: A one-unit increase in the sexual abuse subscale score was associated with a 5% increased risk of IGM/T2D. Research investigating the mechanisms that link childhood sexual abuse with an increased risk for IGM/T2D is needed. 
Keywords: adverse childhood experiences; anxiety; childhood maltreatment; depression; impaired glucose metabolism; prediabetes; type 2 diabetes