For last week’s practice question, we quizzed participants on childhood trauma during diabetes visits. 82% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it by clicking here.
A 19-year-old woman with type 1 diabetes has an A1C of 9.1% reports difficulty using CGM consistently, frequently cancels appointments, and becomes guarded when clinicians ask about self-management behaviors. During a visit, they mention experiencing significant adversity during childhood and says that healthcare settings often make them feel anxious.
Which intervention is most appropriate?
- A. Document the history of childhood adversity and prioritize insulin intensification because the A1C remains above target.
- B. Acknowledge their concerns, ask what would help them feel more comfortable during visits, and collaborate on one self-care goal.
- C. Explore the specific childhood events in greater detail to determine which experiences are contributing to their current diabetes-related behaviors.
- D. Refer her to behavioral health services and postpone further diabetes education until the effects of the past trauma have been addressed.
Getting to the Best Answer
Answer A is incorrect. 2.42% chose this answer: “Document the history of childhood adversity and prioritize insulin intensification because the A1C remains above target.” Insulin intensification may eventually be appropriate, but this response does not address the anxiety, mistrust, or barriers affecting their ability to follow the treatment plan. Insulin changes alone may not improve outcomes when engagement and emotional safety have not been addressed.
Answer B is correct. 81.82% of you chose this answer, “Acknowledge their concerns, ask what would help them feel more comfortable during visits, and collaborate on one self-care goal.” A trauma-informed approach emphasizes safety, trust, choice, collaboration, and empowerment. Asking what would help the person feel more comfortable and developing a realistic self-care goal may strengthen engagement without requiring disclosure of traumatic details. Diabetes treatment and education can continue in a supportive, person-centered manner.
Answer C is incorrect. 4.24% of respondents chose this: “Explore the specific childhood events in greater detail to determine which experiences are contributing to their current diabetes-related behaviors.” Diabetes professionals do not need detailed descriptions of traumatic experiences to provide effective care. Asking for unnecessary details may increase distress or contribute to re-traumatization. The focus should remain on how current experiences affect healthcare participation and diabetes self-management.
Finally, Answer D is incorrect. 11.52% chose this answer, “Exercise physiologists and physical therapists are eligible with a special waiver.” Behavioral health referral may be beneficial, but diabetes care does not be withheld until trauma-related concerns are resolved. The healthcare team can provide trauma-informed diabetes education while also offering appropriate behavioral health resources.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
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Adverse Childhood Experiences' Impact on Health
Understand the link between adverse childhood experiences and diabetes — and learn trauma-informed strategies to foster resilience and improve outcomes.
Adverse childhood experiences (ACEs) are associated with an increased risk of diabetes, heart disease, cancer, and a variety of other health consequences in adults. This course reviews how diabetes care and education specialists can provide screening, assessment, and trauma-informed care to individuals who have experienced ACEs and are living with toxic stress. We’ll explore strategies to address ACEs, improve outcomes for individuals and communities, and support self-care with a focus on recognizing and promoting resilience.
