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Obesity moderates possible link between PTSD, type 2 diabetes in veterans
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Veterans with PTSD and obesity are just as likely to develop incident type 2 diabetes as those without PTSD and obesity, suggesting that excess weight moderates any association between the two conditions, according to findings published in JAMA Psychiatry.
“PTSD may not be a life sentence for chronic health conditions as has been suggested by other studies,” Jeffrey F. Scherrer, PhD, professor in the department of family and community medicine at Saint Louis University School of Medicine, told Endocrine Today. “Diabetes is more common in patients with PTSD due to health behaviors and comorbid conditions. Some research suggests patients with PTSD have a harder time losing weight and making lifestyle changes. Therefore, future research should determine if interventions to change health behaviors need to be tailored to patients with PTSD.”
In a retrospective study, Scherrer and colleagues analyzed Veterans Health Administration medical records from 5,654 patients with (n = 3,450) and without PTSD (n = 2,204) and no diabetes at baseline who had at least two visits between 2008 and 2012 to one of five VA PTSD specialty mental health clinics (mean age, 45 years; 85.7% men; 64.8% white; 43.9% married). For patients with PTSD, the index date was the second visit with a PTSD diagnosis. For controls without PTSD, the index date was the date of a second visit to the specialty clinic. Researchers followed patients for a minimum of 3 years for development of incident type 2 diabetes. Researchers used Cox proportional hazard models to estimate whether the association of PTSD and incident type 2 diabetes remained independent of obesity, with additional models including psychiatric disorders, psychotropic medications, physical conditions and smoking status as variables. Additional models compared the risk for incident type 2 diabetes in patients with PTSD with and without obesity.
Veterans with PTSD were younger vs. those without PTSD (mean age, 43 years vs. 48 years) and more likely to be black (24.7% vs. 16.9%) and not married (55.7% vs. 48.9%). Before adjusting for age, the cumulative incidence of type 2 diabetes was similar between those with and without PTSD (7.3% vs. 6.4%); however, cumulative incidence was higher among those with PTSD after age adjustment (6.6% vs. 4.7%).
After adjusting for age, researchers found veterans with a PTSD diagnosis had a 33% increased risk for incident type 2 diabetes (HR = 1.33; 95% CI, 1.08-1.64); however, the association was no longer significant after obesity was added to the model (HR = 1.16; 95% CI, 0.94-1.43). In a fully adjusted model, there was no association between PTSD and incident type 2 diabetes (HR = 0.84; 95% CI, 0.64-1.1).
Researchers also observed that the cumulative incidence rate of type 2 diabetes was markedly higher among patients with and without PTSD if they had obesity. In patients with PTSD and obesity, the age-adjusted incidence rate was 21 per 1,000 person-years vs. 5.8 per 1,000 person-years for patients with PTSD and no obesity. In patients without PTSD and obesity, the age-adjusted incidence rate was 21.2 per 1,000 person-years vs. 6.4 per 1,000 person-years for those without PTSD and no obesity.
In Cox proportional hazard models estimating the association between obesity and incident type 2 diabetes stratified by PTSD diagnosis, researchers found that obesity was similarly associated with type 2 diabetes incidence in patients with PTSD (HR = 2.72; 95% CI, 1.97-3.77) and without PTSD (HR = 2.73; 95% CI, 1.86-4).
“Re-thinking when to encourage lifestyle change might be relevant,” Scherrer said. “If PTSD is not independently related to incident diabetes, clinicians can take steps to motivate patients with PTSD to modify lifestyle. If patients with PTSD appear to have more barriers to lifestyle modification, future research, which we are conducting, needs to determine if reducing PTSD symptoms enables patients to improve health behaviors.” – by Regina Schaffer
For more information:
Jeffrey F. Scherrer, PhD, can be reached at Saint Louis University School of Medicine, Department of Family and Community Medicine, 402 S Grand Blvd, St. Louis, MO 63104; email: scherrjf@slu.edu.
Disclosure: Scherrer reports he receives compensation as an editor of Family Practice.
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