Resolving PTSD may lower risk for some diabetes-related complications

Key takeaways:

• Microvascular complications appeared less frequently among veterans who no longer met PTSD criteria.
• Younger and middle-aged veterans with improved PTSD had lower mortality risk.

Individuals with type 2 diabetes who experience trauma may be at a lower risk for microvascular complications after resolving PTSD symptoms, according to a results from a retrospective study of U.S. veterans published in JAMA Network Open.

Moreover, researchers reported lower mortality risk and a likelihood of starting insulin among younger and middle-aged veterans who no longer met the criteria for PTSD.

"The driver for this study was [that] we already know PTSD is a risk factor for poor health outcomes, but if it's treated and symptoms largely go away, does the risk change?” Jeffrey F. Scherrer, PhD, a professor in the department of psychiatry and behavioral neuroscience at St. Louis University, told Healio. Previous research has established that PTSD is partially tied to diabetes risk, but “we don't have much information on what happens to people who have both PTSD and diabetes or who have both PTSD and heart disease at the same time, ” he added.

In the retrospective cohort study, the researchers examined data collected between 2011 and 2022 on 10,002 veterans with PTSD and type 2 diabetes (65.3% aged 50 years or older; 87.2% men).

Their investigation compared several diabetes-related health outcomes, such as mortality and glycemic control, between patients who experienced improvement in PTSD — defined as no longer meeting the criteria for a diagnosis — and those who had persistent PTSD.

Before Scherrer and colleagues controlled for cofounders, patients who no longer met the criteria for PTSD had similar incidences of poor glycemic control, starting insulin, microvascular complications and mortality from all causes as those who had persistent PTSD.

However, patients who no longer met the criteria for PTSD diagnosis had a lower risk for microvascular complications (HR = 0.92; 95% CI, 0.85-0.99) after the researchers controlled for confounders.

Additionally, Scherrer and colleagues reported an association between no longer meeting the diagnostic criteria for PTSD and lower risk for mortality (HR = 0.39; 95% CI, 0.19-0.83) and a lower likelihood of starting insulin (HR = 0.69; 95% CI, 0.53-0.88) among veterans aged 18 to 49 years.

Among patients without depression, researchers noted a link between no longer meeting PTSD criteria and a lower likelihood of starting insulin (HR = 0.73; 95% CI, 0.55-0.97).

The results were “a little surprising,” Scherrer said.

“I thought we’d see better glycemic control [and that] those who had the least amount of improvement would also have higher rates of mortality,” he explained.

He suggested that his group’s evaluation may not have observed a significant difference in glycemic control because it is so well managed in the U.S. Department of Veterans Affairs “that we're not getting enough variation over time.”

Scherrer highlighted several potential directions as to where research could go.

“We have found in prior studies that people who do experience large improvements in PTSD are more likely to engage in healthy behaviors [like medication adherence or smoking cessation] but we still don't know if it has a major role in diabetes outcomes,” he said.

Scherrer noted that the key takeaway for primary care providers “is to be aware that active mental illness and PTSD can potentially complicate diabetes management, and if they have a patient with PTSD and who also has diabetes, to make sure that PTSD is well controlled because that might be the best approach to optimizing the diabetes outcomes.”