Victims of partner violence and child abuse face a much higher risk of having type 2 diabetes later in life

August 22, 2023

According to the results of a study recently published in the American Journal of Preventive Medicine, exposure to interpersonal violence throughout childhood or adulthood increases an individual’s chance of developing adult-onset diabetes by more than 20%.

Data showed the risk level is similar among adult males and females, and lower-income Americans, EurekaAlert reports.

Lead investigator Maureen Sanderson, Ph.D., Department of Family and Community Medicine, Meharry Medical College, explains, “While previous research has linked exposure to interpersonal violence with a higher risk for developing type 2 diabetes, our study is the first to confirm a consistent association among different genders and races within a large, diverse population. Moreover, we were able to establish the temporal sequence for experiencing violence and the subsequent risk of developing diabetes over time.”

Previous research has linked lifetime exposure to interpersonal violence or abuse to an increased risk of chronic psychosocial stress, anxiety, depression, and obesity, EurekaAlert notes.

The investigators took a deeper look at the relationship between these factors—particularly obesity, and the risk of developing adult-onset diabetes—using data from the Southern Community Cohort Study, a large study of an economically and ethnically diverse population in the southeastern United States. More than 25,000 participants were contacted multiple times from 2002 to 2015—answering questions about partner violence (including adult psychological harm, physical violence, and threats), child abuse and neglect (physical, sexual, or emotional abuse), and current health (including diagnoses for adult-onset diabetes).

Co-investigator Ann Coker, PhD, Department of Obstetrics and Gynecology, College of Medicine and Center for Research on Violence Against Women, University of Kentucky, notes, “From this uniquely diverse cohort of over 25,000 participants, we saw that two commonly occurring forms of interpersonal violence—partner violence and child abuse (36% and 32%, respectively, in the study group)—increased the risk of developing adult-onset diabetes by 20-35% when compared to individuals in this same cohort who had not experienced interpersonal violence. These forms of violence increase the risk of trauma-associated stress disorders, which can cause adult-onset diabetes.”

Experiencing both child abuse and adult violence increased the risk of developing diabetes by 35% for both Black and White participants, and males and females.

Rates of interpersonal violence, psychosocial distress, and obesity all increased during the COVID-19 pandemic. Dr. Sanderson notes, “Our finding that lifetime interpersonal violence was associated with a significantly increased risk of developing diabetes across race and gender before the additional social stress of the COVID-19 pandemic strongly suggests the need for helping professionals across disciplines to implement effective violence prevention and intervention strategies to reduce the short- and long-term social and health consequences of partner violence and child abuse.”

Dr. Coker added, “The good news is that effective intervention and prevention resources exist that can help patients and communities prevent or reduce partner violence and child abuse/neglect, and have an impact on health outcomes including type 2 diabetes.”

Research contact: @EurekAlert

Sepember 12, 2024

The Centers for Disease Control and Prevention (CDC) reported in back in September 2016 that one in four Medicare participants age 65 or older—that’s 5 million people—do not take their blood pressure medicine as directed. In fact, 20% to 30% of prescriptions for chronic health conditions are never filled, and about half are not taken as prescribed, reports the Association of American Medical Colleges (AAMC).

Patients’ failure to follow their medical treatment regimens is a common and costly problem with potentially dire consequences. A 2012 study by the American College of Preventive Medicine found that nonadherence accounted for an estimated 125,000 deaths annually and at least 10% of hospitalizations. The repercussions also cost the U.S. health system as much as $300 billion a year, according to a 2014 study by Johns Hopkins University researchers.

Depending on the patient, provider, and situation, contributing factors may include the patient’s social and economic status or education level, the complexity of the treatment and instructions, health system variables, poor provider communication, patient depression or stress, or physical or financial obstacles to drug access.

Patients may also stop taking a medication if they experience unpleasant side effects, are not seeing any immediate benefit from the therapy, or if they simply grow tired of taking pills.

medicine we have a blind spot,” said Victor Montori, M.D., an endocrinologist and professor of medicine at the Mayo Clinic. “Being a patient—especially being a patient with a chronic condition—is a lot of work.” And there’s no curriculum about the work of being a patient, he noted.

Adherence rates haven’t changed significantly in the past three decades, despite efforts by the World Health Organization and the Institute of Medicine to address the problem, according to the American College of Preventive Medicine.

In addition to poorer patient outcomes, hospitals now also suffer the costs of readmission penalties for Medicare patients who return to the hospital because they haven’t followed a doctor’s instructions.

There’s no one-size-fits-all remedy for this problem: physicians and health systems can support adherence in a combination of ways.

At Mayo’s Knowledge and Evaluation Research Unit, Montori focuses on “minimally disruptive medicine” that is designed not to overburden patients. He said clinicians often are unaware of the cumulative effects of what they ask patients to do. Montori noted, for example, that patients may have to go through several bureaucratic steps and pharmacy trips to refill each maintenance prescription.

Montori suggests that healthcare systems focus treatment on the goals patients and clinicians agree to achieve, “and then make sure in the process that we don’t overwhelm [the patients].” In some cases, it’s virtually impossible for patients to do all that their providers ask, Montori says. “Are the treatments, tests, appointments, that we’re asking people to go through, are they really necessary?” he asked. “If we medicalize every moment of their lives, patients will struggle.”

In addition to being more judicious about how many appointments are necessary, the healthcare team can make it easier for patients by trying to bundle appointments or procedures on the same day, he suggests. Or clinicians can help mobilize social resources for patients who need help with housing, food, or addictions—factors that can affect their ability to maintain a treatment regimen, Montori said.

Prescribing more affordable generic drugs, simplifying dosages, synchronizing refills, and finding ways to reduce pharmacy trips may reduce the burden on patients as well, Montori adds. Or, if the patient has stopped taking a medication because of unpleasant side effects, the physician can work with the pharmacist to find an alternative.

At NYU School of Medicine, Adina Kalet, MD, MPH, professor of medicine and surgery and codirector of the Program on Medical Education Innovation and Research, is exploring the use of a Patient Empowerment Program to help patients become more active partners in their care. In a current study, she and colleagues are training patients with diabetes to better communicate with physicians during two two-hour sessions.

So far, said Kalet, “it does what we are hoping it [would do]…. It changes the dynamic in the doctor’s office. We’ve had nothing but positive responses from physicians about how much more satisfying it is to be able to engage as partners with patients.”

For Steven Feldman, MD, PhD, professor of Dermatology, Pathology, and Public Health Sciences at Wake Forest Baptist Medical Center, close follow-up and establishing trust with patients are the keys to patient adherence. Prescribing a drug and then following up in 8 weeks to 12 weeks is not enough to ensure compliance, he says.

“Doctors are the only people on the planet who have the idea that you can tell people, ‘Here, work on this every day and I’ll see you in two or three months.’”

Feldman has found that being a caring provider leads to better patient accountability. When prescribing a new treatment, for example, he writes his mobile phone number on a business card and tells his patient to call in three days to report on progress. “That adds to their trust in me, which adds to their trust in the medicine,” Feldman says.

Wake Forest has spun off a company based on Feldman’s adherence-improvement methods, asking patients to report their treatment status through online surveys. Using that approach, acne patients doubled their adherence to treatments.

Providers may do well to remember that the intangible can be invaluable. “It is the relationship between the doctor and patient that drives the compliance,” says Helen Shields, MD, associate chief of Brigham and Women’s Hospital, Division of Medical Communications.

“I believe strongly that patients are more compliant if they trust you, believe you, and if they can understand what you’re saying.”

Research contact: @AAMCtoday