PTSD Management Might Lower Risk of Complications in Veterans with Diabetes: JAMA

A new study published in the Journal of American Medical Association found that reducing symptoms of posttraumatic stress disorder (PTSD) may lower the risk of adverse outcomes in veterans with comorbid type 2 diabetes (T2D). This research by the U.S. Veterans Health Administration (VHA) examined data from over a decade and illuminates the potential benefits of managing PTSD in reducing complications associated with diabetes.

The study analyzed medical records of 10,002 veterans aged 18 to 80 years from October 1, 2011 to September 30, 2022, all of whom had been diagnosed with both PTSD and T2D. The cohort predominantly consisted of men (87.2%), with a significant portion being older than 50 years (65.3%). The participants were diverse, with 62.7% identifying as White, 31.6% as Black, and 5.7% as other races.

This research wanted determine whether veterans who showed improvement in PTSD symptoms experienced better outcomes in managing their diabetes when compared to the participants with persistent PTSD symptoms. PTSD improvement was measured using the PTSD Checklist, with a score of less than 33 indicating significant symptom reduction.

The findings of this study suggest that managing PTSD could be beneficial in lowering the risk of certain diabetes-related complications. Before controlling for various factors, the incidence rates of major diabetes outcomes like insulin initiation, poor glycemic control, microvascular complications and all-cause mortality, were similar between veterans who improved their PTSD symptoms and the individuals who did not.

However, the results showed that veterans who no longer met PTSD diagnostic criteria had a reduced risk of microvascular complications by 8% when compared to the patients with persistent PTSD symptoms after adjusting for confounding factors. This association suggests that PTSD might be a modifiable risk factor, particularly in relation to the management of diabetes complications.

Further analysis revealed that the impact of PTSD improvement varied among different groups. The veterans aged 18 to 49 who no longer met PTSD criteria had a 31% lower risk of starting insulin and a striking 61% reduction in the risk of all-cause mortality. Also, among veterans without depression, the individuals who no longer met PTSD criteria had a 27% lower risk of requiring insulin.

Overall, the study highlights the potential benefits of effectively managing PTSD symptoms in veterans with T2D. While the findings indicate a modest reduction in microvascular complications, they also underline the importance of addressing PTSD as a modifiable risk factor in the broader management of diabetes.

Source:

Scherrer, J. F., Salas, J., Wang, W., Freedland, K. E., Lustman, P. J., Schnurr, P. P., Cohen, B. E., Jaffe, A. S., & Friedman, M. J. (2024). Posttraumatic Stress Disorder and Type 2 Diabetes Outcomes in Veterans. In JAMA Network Open (Vol. 7, Issue 8, p. e2427569). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.27569