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.
Li et al. (2026) studied this question.