Study Finds Link Between PTSD Treatment and Diabetes Risk Reduction in Veterans

A recent study found that when veterans no longer meet the diagnostic criteria for posttraumatic stress disorder (PTSD), they are at a lower risk for poor diabetes outcomes, especially if they are younger. This research, led by Jeffrey F. Scherrer, Ph.D., from the Saint Louis University School of Medicine, was published online on August 13 in JAMA Network Open.

The study looked at 10,002 veterans, 65.3% being 50 or older and 87.2% being men. The researchers aimed to understand how PTSD affects the health of veterans who also have type 2 diabetes. They specifically compared the diabetes-related health outcomes of veterans whose PTSD symptoms improved to those whose symptoms remained the same.

The study analyzed several key health outcomes related to diabetes. These included the need to start insulin treatment, the control of blood sugar levels, the occurrence of complications in small blood vessels (known as microvascular complications), and the overall mortality rate.

The researchers found that before adjusting for other influencing factors, there was little difference in these health outcomes between veterans whose PTSD had improved and those who still met the criteria for PTSD. For example, the rates of starting insulin were 22.4 per 1,000 person-years for those with improved PTSD and 24.4 per 1,000 person-years for those with persistent PTSD. Similarly, poor blood sugar control rates were 137.1 versus 133.7 per 1,000 person-years.

However, once the researchers adjusted for other factors that could affect the results, they noticed that veterans who no longer met the criteria for PTSD had a slightly lower risk of microvascular complications. This means that their risk of developing complications in small blood vessels was reduced compared to those with ongoing PTSD.

For younger veterans aged 18 to 49, the study found an even more significant reduction in health risks. These veterans had a lower chance of needing insulin and a much lower risk of dying from any cause. Additionally, among veterans who did not have depression, those who no longer met the PTSD criteria were less likely to start insulin treatment.

The authors of the study suggested that PTSD could be a changeable risk factor that impacts some adverse health outcomes in veterans who have both PTSD and type 2 diabetes.

Dr. Scherrer shared that the results of the study were somewhat unexpected, as he anticipated seeing better control of blood sugar levels in those whose PTSD symptoms had improved. He also thought that veterans with less improvement in their PTSD would have higher mortality rates. He suggested that the study might not have observed significant differences in blood sugar control because this aspect of diabetes is already well-managed within the U.S. Department of Veterans Affairs, leading to little variation in outcomes over time.

Dr. Scherrer also pointed out several areas for future research. He mentioned that in previous studies, individuals who showed significant improvements in PTSD symptoms were more likely to engage in healthier behaviors, such as taking their medications regularly or quitting smoking. However, it is still unclear if these positive behaviors significantly impact diabetes outcomes.

He emphasized that primary care providers should be aware that mental health conditions, including PTSD, can complicate the management of diabetes. Therefore, for patients with both PTSD and diabetes, it is crucial to ensure that the PTSD is well-controlled. Doing so might be the best strategy for improving their diabetes outcomes.