Effect of Posttraumatic Stress Disorder and Obesity on Type 2 Diabetes

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Obesity was significantly associated with a type 2 diabetes diagnosis in patients with and without PTSD.
Obesity was significantly associated with a type 2 diabetes diagnosis in patients with and without PTSD.

Posttraumatic stress disorder (PTSD) does not have a causal relationship with type 2 diabetes, but obesity remains a risk factor, according to a study published in JAMA Psychiatry.

Researchers of this retrospective study analyzed the records of Veterans Health Administration patients who were diagnosed with PTSD (n=3450) and those without PTSD (n=2204). Study variables included demographic data, vital signs, laboratory results, diagnoses, and medication. The primary outcomes were to identify the incident of type 2 diabetes and to examine the relationship obesity has with that diagnosis. Obesity was represented by a body mass index of ≥30 or an International Classification of Diseases-9 code for obesity. Psychiatric disorders, substance abuse or dependency, sleep disorders, hypertension, and hyperlipidemia were controlled covariates.

Patients with PTSD were more likely to be men (86.5%; P =.03), black (24.7%; P <.001), and not married (55.7%; P <.001). They were also more likely to be diagnosed with depression (73.2%; P <.001), anxiety (33.1%; P <.001), sleep disorders (58.6%; P <.001), alcohol abuse or dependency (31.1%; P <.001), hypertension (47.6%; P =.003), hyperlipidemia (49.4%; P <.001), and obesity (59.1%; P <.001). After controlling for age, patients with PTSD had a higher prevalence of type 2 diabetes (6.6%; P =.002) and also had an increase in probability of a diagnosis of type 2 diabetes of 33% (hazard ratio [HR], 1.33; 95% CI, 1.08-1.64; P =.01).

When the data was analyzed using Cox proportional hazard models, obesity was significantly associated with a type 2 diabetes diagnosis in patients with and without PTSD (HR, 3.66 [95% CI, 2.67-5.02]; P <.001; HR, 3.75 [95%CI, 2.60-5.40]; P <.001, respectfully). These results point to obesity, rather than a PTSD diagnosis, being a risk factor for a type 2 diabetes diagnosis.

Future studies need to address the relationship between PTSD, type 2 diabetes, and obesity in civilians, increase follow-up times, and explore whether PTSD remission, along with weight control, can reduce the occurrence of type 2 diabetes.

Researchers conclude that obesity is an independent risk factor of type 2 diabetes, regardless of a PTSD diagnosis. 

This study was supported by the National Heart Lung and Blood Institute. Please refer to reference for a complete list of authors' disclosures.

Reference

Scheere JF, Salas J, Lustman PJ, et al. The role of obesity in the association between posttraumatic stress disorder and incident diabetes [published online August 8, 2018]. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2018.2028

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