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Type 2 Diabetes Among People With Posttraumatic Stress Disorder: Systematic Review and Meta-Analysis
Davy Vancampfort1, Simon Rosenbaum, Philip B Ward
1From KU Leuven Department of Rehabilitation Sciences (Vancampfort) and the University Psychiatric Centre, Leuven-Kortenberg, Belgium (Vancampfort); School of Psychiatry (Rosenbaum, Ward, Steel, Lederman), University of New South Wales, Sydney, NSW, Australia; Department of Pharmacy, Faculty of Medicine (Lamwaka), Gulu University, Uganda; School of Public Health & Charles Perkins Centre (Richards), University of Sydney, Sydney, NSW, Australia; Physiotherapy Department (Stubbs), South London and Maudsley NHS Foundation Trust, London, United Kingdom; and Health Service and Population Research Department (Stubbs), Institute of Psychiatry, King's College London, London, United Kingdom.
Objective:
To clarify the prevalence and predictors of Type 2 diabetes mellitus (T2DM) in people with posttraumatic stress disorder (PTSD) and where possible compare this to healthy controls.
Methods:
We searched major electronic databases until May 2015 for studies reporting T2DM prevalence in people with PTSD. Two independent authors extracted data and completed methodological quality appraisal. A random-effects meta-analysis was used.
Results:
From 1171 candidate publications after exclusions, nine publications were included (n = 23,396; 28.6% male; mean age = 35-60 years). The overall prevalence of T2DM was 10.0% (95% confidence interval [CI] = 8.1%-12.0%). Subgroup analysis demonstrated that war veterans experience higher prevalence of T2DM (16.3%; 95% CI = 5.2%-31.8%; n studies = 3, n = 473) compared with mixed samples (11.8%; 95% CI = 6.34-18.7, p < .001; n studies = 4, n = 2753). Increasing age (β = 0.0593, 95% CI = 0.010-0.109, z = 2.34, p = .019), median year of publication (β = -0.08, 95% CI = -0.14 to -0.03, z = -3.09, p = .002), and a lower percentage of white participants (β = -3.21, 95% CI = -5.12 to -1.29, z = -2.28, p = .001) predicted prevalence of T2DM. A relative risk meta-analysis comparing controls (n = 125,723) against those with PTSD (n = 23,203) demonstrated a significantly increased risk of T2DM (n studies = 5, relative risk = 1.49, 95% CI = 1.17-1.89, p = .001).
Conclusions:
People with PTSD are at a high risk for developing T2DM. The current findings should, however, be interpreted with caution because most studies were based on self-report data.
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