Type 2 diabetes outcomes in patients with Posttraumatic stress disorder and psychiatric comorbidity

Posttraumatic stress disorder (PTSD) is associated with type 2 diabetes (T2D). However, no studies have determined if risk for adverse T2D outcomes vary among different PTSD comorbidity patterns.

We identified 152,171 Veterans Health Administration (VHA) patients with de-identified medical records who had comorbid PTSD and T2D. All had adequate HbA1c control, not on insulin, and were free of microvascular and macrovascular complications at index. Latent class analyses (LCA) identified 3 comorbidity profiles characterized as depression + anxiety; high comorbidity; and low comorbidity. We then estimated the link between comorbidity classes and risk for adverse T2D outcomes and all-cause mortality.

Most (64.4%) of the sample was ≥ 60 years of age, male (90.9%), and White race (69.1%). High comorbidity vs. low comorbidity and depression + anxiety vs. low comorbidity were associated with all-cause mortality (HR = 1.39; 95%CI:1.28-1.50 and HR = 1.18;95%CI:1.14-1.23, respectively). The depression + anxiety vs. the low comorbidity class, had slightly worse glycemic control (HR = 1.04; 95%CI:1.02-1.06) and microvascular complications (HR = 1.04; 95%CI:1.02-1.06).

More psychiatric comorbidity in patients with PTSD is associated with worse glycemic control, increased risk for T2D micro- and macro- complications, and mortality. Research is needed to determine if treatment and improvement in patients with comorbid psychiatric disorders leads to improved T2D outcomes.