Reduction in clinically meaningful PTSD symptoms may reduce T2DM risk
Clinically meaningful reductions in post-traumatic stress disorder (PTSD) symptoms are associated with a lower risk of type 2 diabetes mellitus (T2DM), according to a recent study in veterans.
In the study, older age (mean, 43.6 years vs 41.7 years; p=0.02) and minimally adequate duration of PTSD psychotherapy (59.0 percent vs 42.6 percent; p<0.001) were associated with a clinically meaningful PTSD Checklist (PCL) score decrease (ie, PCL score decrease ≥20). On the other hand, receipt of acute-phase antidepressant medication (76.2 percent vs 68.4 percent; p=0.004) as well as antipsychotic fill (30.8 percent vs 23.6 percent; p<0.001) were significantly more prevalent in those with a PCL score decrease <20. No significant difference was, however, demonstrated in the distribution of psychiatric comorbidities and physical comorbidities between the groups. [JAMA Psychiatry 2019, doi: 10.1001/jamapsychiatry.2019.2096]
Further analysis revealed that a PCL score decrease of ≥20 was associated with a significantly lower risk of developing T2DM (hazard ratio [HR], 0.49; 95 percent CI, 0.26 to 0.95; p=0.03) after adjustment for age, hypertension, obesity, and hyperlipidaemia. Depression symptoms (measured by Patient Health Questionnaire), but not BMI and HbA1c values, decreased in patients who experienced clinically meaningful PTSD improvement.
The overall T2DM incidence rate was 18.0 per 1,000 person-years. The age-adjusted T2DM incidence rate was significantly lower among patients with a clinically meaningful PCL score decrease (7.3 per 1,000 person-years vs 16.0 per 1000 person-years; p=0.005).
This retrospective cohort study included data from a total of 1,598 patients (mean age, 42.1 years; male, 84.3 percent). Eligible patients had one or more PCL score of ≥50 between the initial 3-year period and a second PCL score within the following 12 months measured at least 8 weeks after the first score. Patients were free of T2DM diagnosis or any antidiabetic medication use for 12 months before after the first PCL score, and had at least 1 visit afterwards.
PTSD affects up to 30 percent of the veteran population and is associated with increased risk of multiple comorbidities. Psychotherapy is effective in improving not only mental health, but also physical health. Previous studies suggested that the association between PTSD and elevated risk of T2DM might be due to the high prevalence of obesity and metabolic syndrome in patients with PTSD. [J Psychiatr Res 2016;82:16-22; World Psychiatry 2010;9:3-10; J Consult Clin Psychol 2012;80(2):201-210; Psychoneuroendocrinology 2019;100:254-263; Psychiatry 2018;75:1189-1198; Metabolism 2015;64:926-933]
Findings of the current study implied that a decrease in PCL score might help in mitigating the risk of T2DM in patients, and the potential health benefits of PTSD treatment might encourage psychotherapy use.