Severely Injured Warriors More Likely to Develop Diabetes

by U.S. Medicine

April 7, 2016

TRAVIS Air Force Base, CA — Severity of combat injuries influences the risk of Iraq and Afghanistan war veterans to develop diabetes and other chronic diseases, according to a new study.

The report, published recently in the journal Circulation, notes that, in the past 13 years of war, 52,087 U.S. servicemembers were wounded in combat. Study authors from Travis Air Force Base, CA, suggest that chronic diseases occurring after combat injuries might be a hidden cost of the conflicts.1

“The more severely a servicemember is injured, the more likely they are to develop a wide variety of chronic medical conditions, including high blood pressure, diabetes, chronic kidney disease and hardening of the arteries,” said lead author Maj. Ian J. Stewart, MD, of the David Grant U.S. Air Force Medical Center, Fairfield, CA.

“I have seen firsthand that our soldiers, sailors, airmen and Marines get the finest trauma and follow-up care,” Stewart added in an American Heart Association press release. “Our study lays important groundwork to better understand the longer-term effects of combat-related injury on the risk of chronic disease.”

For the study, researchers analyzed 3,846 soldiers’ Injury Severity Scores (ISS) and examined its relation with the subsequent development of chronic medical conditions. The ISS ranges from 1 to 75, with 1 being a minor injury and 75 being a severe, likely unsurvivable injury.

All injuries were severe enough to require admission to an intensive-care unit, and only data from servicemembers’ first admission from February 2002 to February 2011 were analyzed. Study subjects were followed until they died, left the military healthcare system or until January 2013, whichever came first.

Results indicate that, for every 5 points that the ISS rose, the risk of high blood pressure increased by 6%; coronary artery diseases and diabetes by 13%; and chronic kidney disease by 15%.

Researchers also found that those who developed chronic illnesses tended to be older, have higher average ISS and more acute kidney injury. In fact, when trauma was complicated by acute kidney injury, the risk of high blood pressure increased by 66%, and the risk of chronic kidney disease was almost five times more likely.

The study found that injured black servicemembers had 69% higher rates of high blood pressure compared with injured whites.

Notably, according to the authors, the ISS score was associated with an increased incidence of each chronic illness, independent of the risk of death. That held even after considering age, race, heart rate, presence of burn injury and acute kidney injury.

For the most-severely-injured patients, the rates of high blood pressure, coronary artery disease and diabetes were notably higher compared with rates for the overall U.S. military population.

Researchers posited that the body’s inflammatory response could be responsible for the higher rates of chronic diseases, noting that post-traumatic stress disorder, common in combat casualties, might lead to similar results directly through an inflammatory response or indirectly from weight gain or substance abuse.

1 Stewart IJ, Sosnov JA, Howard JT, Orman JA, Fang R, Morrow BD, Zonies DH, Bollinger M, Tuman C, Freedman BA, Chung KK. Retrospective Analysis of Long-Term Outcomes After Combat Injury: A Hidden Cost of War. Circulation. 2015 Dec 1;132(22):2126-33. doi: 10.1161/CIRCULATIONAHA.115.016950. Epub 2015 Nov 2. PubMed PMID: 26621637.

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