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February 2, 2026Open Access

Association Between Adverse Childhood Experiences and Diabetes in Chinese Adults: The Mediating Role of Lifestyles

HLHaomiao LiWuhan University RCRuojie ChengHunan University JWJiahuan WanSouthern Medical University

Key Points

This study aims to explore the relationship between adverse childhood experiences and diabetes, focusing on lifestyle as a mediating factor.
Utilized a nationwide cross-sectional survey (PBICR-2023) in China.
Analyzed data from 27,322 adults to assess correlations among ACEs, diabetes, and comorbidities.
Applied regression models to evaluate the influences of ACEs on diabetes, adjusting for confounding factors.
Tested mediation effects of lifestyle factors (sleep quality, smoking, diet, physical activity) using Sobel–Goodman tests and KHB decomposition.
Participants exposed to increasing numbers of ACEs showed higher risk for diabetes compared to those with no ACEs.
ACEs were also linked to a greater prevalence of comorbidities in diabetes patients.
Sleep quality had the strongest mediating effect (11.86%), followed by smoking (3.90%), dietary habits (2.96%), and physical activity (1.11%).
For comorbidity, smoking was identified as the only significant mediator (10.20%).

Abstract

The correlation between adverse childhood experiences (ACEs) and both diabetes mellitus (DM) prevalence and comorbidity is an underexplored research area in China. Understanding the mechanisms by which this relationship might be attenuated or mitigated is crucial. This study examines the correlation between ACEs and DM, including its comorbidities, and assesses whether lifestyle factors mediate this relationship in a Chinese population. Data were obtained from the 2023 Psychological and Behavioural Survey of Chinese Residents (PBICR‐2023), a nationwide cross‐sectional survey. The sample included 27,322 adults. Regression models evaluated the associations between ACEs, DM, and comorbidities, adjusting for potential confounders. Mediation effects of lifestyle (sleep quality, smoking, diet and physical activity PA) were tested using Sobel–Goodman tests, with mediation weights quantified via Karlson–Holm–Breen (KHB) decomposition. The results show that, compared with no ACEs, exposure to 1, 2, 3 or ≥ 4 ACEs was significantly associated with higher DM risk. ACEs were also positively correlated with comorbidity among DM patients. Lifestyle mediated the ACE–DM association, with sleep quality having the strongest effect (11.86%), followed by smoking (3.90%), dietary habits (2.96%) and PA (1.11%). For comorbidity, smoking was the only significant mediator (10.20%). Diabetes prevention strategies should address childhood adversities and promote healthier lifestyles.

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