PTSD Symptom Improvement Reduces Type 2 Diabetes Risk

Jeffrey Scherrer, PhD

A clinically meaningful reduction in post-traumatic stress disorder (PTSD) symptoms could lower the risk of type 2 diabetes (T2D).

In a new cohort study, investigators led by Jeffrey F. Scherrer, PhD, Department of Family and Community Medicine, Saint Louis University School of Medicine, examined medical record data from the Veterans Health Affairs of 5916 patients who received PTSD specialty care between 2008-2012 with a follow-up in 2015.

The team discovered meaningful PTSD improvement compared with less than clinically meaningful or no improvement was linked with a 49% lower risk of incident type 2 diabetes.

Of the 5916 patients, the investigators used the medical records from 1598 patients, 1347 of which were male and 1060 of which were white with a mean age of 42.

PTSD has long been associated with an increased risk of type 2 diabetes. However, as PTSD symptoms improve, most patients self-reported physical health and hypertension improvements, but it is unknown whether or not PTSD improvements decreases the risk of type 2 diabetes.

In the study, eligible patients had 1 or more PTSD Checklist (PCL) scores of 50 or higher between 2008-2012 and a second PCL score within the following 12 months and at least 8 weeks after the first PCL score of 50 or higher.

The index date was 12 months after the first PCL score and patients were free of a type 2 diabetes diagnosis or an antidiabetic medication use for 12 months before the index date and had at least 1 visit after the index date.

The investigators defined patients as those with a clinically meaningful improvement—more than a 20-point PCL score decrease—or those with less or no improvement—less than a 20-point PCL score decrease.

“The age-adjusted cumulative incidence of T2D was 2.6% among patients with a clinically meaningful PCL score decrease and 5.9% among patients without a clinically meaningful PCL score decrease (P = .003),” the authors wrote. “After control for confounding, patients with a clinically meaningful PCL score decrease were significantly less likely to develop T2DM compared with those without a clinically meaningful decrease (HR, .51; 95% CI, .26-.98).”

The team believes the study could yield better therapies and treatments to reduce the risk of type 2 diabetes.

“The findings suggest that clinically meaningful reductions in PTSD symptoms are associated with a lower risk of T2D,” the authors wrote. “A decrease in PCL score, whether through treatment or spontaneous improvement, may help mitigate the greater risk of T2D in patients with PTSD.”

In 2015, investigators found that PTSD may elevate the risk of type 2 diabetes mellitus (T2DM) in women.

The authors suggested that clinicians screen PTSD patients routinely for T2DM risk factors and development, particularly increased BMI. The study authors also proposed future research on the role of stress-induced inflammation in T2DM development.

The study, “Association Between Clinically Meaningful Posttraumatic Stress Disorder Improvement and Risk of Type 2 Diabetes,” was published online in JAMA Psychiatry.