Posttraumatic Stress Disorder and Type 2 Diabetes Outcomes in Veterans

Area of Science:

• Endocrinology and Metabolism
• Psychiatry and Mental Health
• Public Health and Epidemiology

Background:

• Posttraumatic stress disorder (PTSD) is linked to a lower risk of developing type 2 diabetes (T2D).
• However, the impact of PTSD on existing T2D outcomes remains largely unknown.
• Investigating PTSD as a modifiable risk factor for T2D complications is crucial.

Purpose of the Study:

• To determine if remission of PTSD symptoms is associated with a reduced risk of adverse T2D outcomes.
• To compare outcomes in patients with PTSD who improved versus those with persistent PTSD.

Main Methods:

• Retrospective cohort study utilizing US Veterans Health Administration data (2011-2022).
• Included patients aged 18-80 with comorbid PTSD and T2D.
• Analyzed outcomes including insulin initiation, glycemic control, microvascular complications, and mortality using survival and competing risk models.

Main Results:

• After controlling for confounding factors, remission of PTSD was associated with a lower risk of microvascular complications (HR, 0.92).
• In younger veterans (18-49 years), PTSD remission lowered the risk of insulin initiation (HR, 0.69) and all-cause mortality (HR, 0.39).
• Among patients without depression, PTSD remission also reduced the risk of insulin initiation (HR, 0.73).

Conclusions:

• Posttraumatic stress disorder (PTSD) appears to be a modifiable risk factor for type 2 diabetes (T2D).
• PTSD remission is associated with a modest reduction in microvascular complications.
• Further research is needed to confirm these findings in diverse healthcare settings.