LOUIS—Improving post-traumatic stress disorder symptoms, a laudable goal itself, has the added benefit of lowering patients’ risk for developing Type 2 diabetes, according to a new report.
A cohort study by Jeffrey Scherrer, PhD, professor of family and community medicine at Saint Louis University School of Medicine, and VA researchers across the country, determined that “clinically meaningful” symptom reduction cut the risk of developing Type 2 diabetes by 49% over a two- to six-year period. The study appeared in JAMA Psychiatry.1
Previous studies have found that PTSD increases the risk of Type 2 diabetes, so the news that PTSD symptom improvement also lowered the risk of diabetes provides an additional impetus to treatment, particularly for veterans. While 12% of civilians have PTSD, the condition affects nearly 30% of veterans. Veterans also have a significantly greater risk of diabetes than civilians.
“Some long-term chronic health conditions associated with PTSD may be less likely to occur among patients who experience clinically meaningful symptom reduction either through treatment or spontaneous improvement,” Scherrer said.
The researchers defined clinically meaningful as an improvement of 20 points or more on the PTSD Checklist score. That level of symptom reduction has been linked to improvements in depression, sleep, blood pressure, back pain, headache, overall emotional well-being and perceived health.
“PTSD and diabetes link through a few channels,” explained co-author Sonya Norman, PhD, PTSD consultation program director at the VA National Center for PTSD, and professor of clinical psychiatry at the University of California-San Diego. Those include dysregulation of the hypothalamic-pituitary-adrenal axis, cortisol levels and inflammation, which are all risk factors in both conditions.
Individuals with PTSD are also more likely to have glucose dysregulation, metabolic syndrome, depression and obesity than individuals who do not have PTSD, according to the researchers.
“PTSD is exhausting, patients have trouble concentrating as they are reminded of the trauma constantly and work hard to avoid the memories and triggers,” Norman told U.S. Medicine. “As PTSD gets better, the person has better ability to focus on other aspects of their life and health. That might be part of the relationship, too.”
The retrospective study analyzed medical records from 1,598 randomly selected veterans who sought care at a PTSD specialty clinic at one of five VHA medical centers across the U.S. between 2008 and 2012. Patients were followed until fiscal year 2015. All had initial PTSD checklist scores above 50 and had another assessment between two and 12 months of their first score of 50 or higher. None had a diagnosis of diabetes at the start of the study.
Depression scores improved with patients who had meaningful reduction in PTSD symptoms. In veterans with PTSD but not depression, improvement in PTSD symptoms reduced diabetes risk. In those with both PTSD and depression, both conditions needed to improve to reduce the risk of diabetes.
“These findings suggest that improved depression does not account for our results but may be a necessary component for an association with lower T2D risk among patients with PTSD and comorbid depression,” the authors wrote.
Improvement in PTSD symptoms also led to improvement in glycemic control and insulin resistance, Norman said. Improvement in depression has been shown to have the same benefits.
Notably, neither body mass index nor hemoglobin A1c values decreased in patients who had at least a 20-point improvement in PCL scores.
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