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Association Between Clinically Meaningful Posttraumatic Stress Disorder Improvement and Risk of Type 2 Diabetes.

Abstract

Importance

Posttraumatic stress disorder (PTSD) is associated with increased risk of type 2 diabetes (T2D). Improvement in PTSD has been associated with improved self-reported physical health and hypertension; however, there is no literature, to our knowledge, on whether PTSD improvement is associated with T2D risk.

Objective

To examine whether clinically meaningful PTSD symptom reduction is associated with lower risk of T2D.

Design, Setting, and Participants

This retrospective cohort study examined Veterans Health Affairs medical record data from 5916 patients who received PTSD specialty care between fiscal years 2008 and 2012 and were followed up through fiscal year 2015. Eligible patients had 1 or more PTSD Checklist (PCL) scores of 50 or higher between fiscal years 2008 and 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. Patients were free of T2D diagnosis or an antidiabetic medication use for 12 months before the index date and had at least 1 visit after the index date. Data analyses were completed during January 2019.

Exposures

Reduction in PCL scores during a 12-month period was used to define patients as those with a clinically meaningful improvement (≥20-point PCL score decrease) and patients with less or no improvement (<20-point PCL score decrease).

Main Outcomes and Measures

Incident T2D diagnosed during a 2- to 6-year follow-up.

Results

Medical records from a total of 1598 patients (mean [SD] age, 42.1 [13.4] years; 1347 [84.3%] male; 1060 [66.3%] white) were studied. 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). 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 (hazard ratio, 0.51; 95% CI, 0.26-0.98).

Conclusions and Relevance

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

Authors+Show Affiliations

Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri. Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri.Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri. Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri.National Center for PTSD, Veterans Affairs (VA) Center of Excellence for Stress and Mental Health, Department of Psychiatry, University of California, San Diego.National Center for PTSD, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center (VAMC), Cincinnati, Ohio. Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio.Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville.Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas.Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri.School of Medicine, Department of Medicine, University of California, San Francisco. San Francisco VAMC, San Francisco, California.National Center for PTSD, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri. The Bell Street Clinic Opioid Treatment Program, Mental Health Service, VA St Louis Health Care System, St Louis, Missouri.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31433443

Citation

Scherrer, Jeffrey F., et al. "Association Between Clinically Meaningful Posttraumatic Stress Disorder Improvement and Risk of Type 2 Diabetes." JAMA Psychiatry, 2019.
Scherrer JF, Salas J, Norman SB, et al. Association Between Clinically Meaningful Posttraumatic Stress Disorder Improvement and Risk of Type 2 Diabetes. JAMA Psychiatry. 2019.
Scherrer, J. F., Salas, J., Norman, S. B., Schnurr, P. P., Chard, K. M., Tuerk, P., ... Lustman, P. J. (2019). Association Between Clinically Meaningful Posttraumatic Stress Disorder Improvement and Risk of Type 2 Diabetes. JAMA Psychiatry, doi:10.1001/jamapsychiatry.2019.2096.
Scherrer JF, et al. Association Between Clinically Meaningful Posttraumatic Stress Disorder Improvement and Risk of Type 2 Diabetes. JAMA Psychiatry. 2019 Aug 21; PubMed PMID: 31433443.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association Between Clinically Meaningful Posttraumatic Stress Disorder Improvement and Risk of Type 2 Diabetes. AU - Scherrer,Jeffrey F, AU - Salas,Joanne, AU - Norman,Sonya B, AU - Schnurr,Paula P, AU - Chard,Kathleen M, AU - Tuerk,Peter, AU - Schneider,F David, AU - van den Berk-Clark,Carissa, AU - Cohen,Beth E, AU - Friedman,Matthew J, AU - Lustman,Patrick J, Y1 - 2019/08/21/ PY - 2020/08/21/pmc-release PY - 2019/8/22/entrez PY - 2019/8/23/pubmed PY - 2019/8/23/medline JF - JAMA psychiatry JO - JAMA Psychiatry N2 - Importance: Posttraumatic stress disorder (PTSD) is associated with increased risk of type 2 diabetes (T2D). Improvement in PTSD has been associated with improved self-reported physical health and hypertension; however, there is no literature, to our knowledge, on whether PTSD improvement is associated with T2D risk. Objective: To examine whether clinically meaningful PTSD symptom reduction is associated with lower risk of T2D. Design, Setting, and Participants: This retrospective cohort study examined Veterans Health Affairs medical record data from 5916 patients who received PTSD specialty care between fiscal years 2008 and 2012 and were followed up through fiscal year 2015. Eligible patients had 1 or more PTSD Checklist (PCL) scores of 50 or higher between fiscal years 2008 and 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. Patients were free of T2D diagnosis or an antidiabetic medication use for 12 months before the index date and had at least 1 visit after the index date. Data analyses were completed during January 2019. Exposures: Reduction in PCL scores during a 12-month period was used to define patients as those with a clinically meaningful improvement (≥20-point PCL score decrease) and patients with less or no improvement (<20-point PCL score decrease). Main Outcomes and Measures: Incident T2D diagnosed during a 2- to 6-year follow-up. Results: Medical records from a total of 1598 patients (mean [SD] age, 42.1 [13.4] years; 1347 [84.3%] male; 1060 [66.3%] white) were studied. 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). 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 (hazard ratio, 0.51; 95% CI, 0.26-0.98). Conclusions and Relevance: The findings suggest that clinically meaningful reductions in PTSD symptoms are associated with a lower risk of T2D. A decrease in PCL score, whether through treatment or spontaneous improvement, may help mitigate the greater risk of T2D in patients with PTSD. SN - 2168-6238 UR - https://www.unboundmedicine.com/medline/citation/31433443/Association_Between_Clinically_Meaningful_Posttraumatic_Stress_Disorder_Improvement_and_Risk_of_Type_2_Diabetes L2 - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/jamapsychiatry.2019.2096 DB - PRIME DP - Unbound Medicine ER -