Associations between posttraumatic stress disorder and hemoglobin A1C in low-income minority patients with diabetes
Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA. General hospital psychiatry
(Impact Factor: 2.61).
03/2011; 33(2):116-22. DOI: 10.1016/j.genhosppsych.2010.12.005
Posttraumatic Stress Disorder (PTSD) is prevalent among low-income minorities and is associated with poorer health. However, the association between PTSD and hemoglobin A1(C) (A1(C)) among patients with diabetes has not been fully described. The objective of this cross-sectional study was to evaluate associations between PTSD and A1(C) among low-income minorities with diabetes.
Adults with diabetes were recruited from a network of primary care clinics. Data were obtained from surveys and electronic medical records. Lifetime PTSD symptoms were assessed using the Structured Clinical Interview-DSM-IV and depressive symptoms with the Patient Health Questionnaire-9. A1(C) was obtained from chart review.
Of 103 adults analyzed, 12% had lifetime full PTSD and 12% had subthreshold PTSD. On backward stepwise logistic regression, patients with any PTSD symptoms were significantly more likely to have an A1(C) >7% compared to patients without symptoms (OR(adj) 2.98, 95% CI 1.04-8.52, P=.04). An A1(C) >7% also was associated with an interaction between PTSD symptoms and longer diabetes duration (P<.05).
In this cohort of low-income minorities with diabetes, lifetime PTSD symptoms were significantly associated with an A1(C) >7%.
Available from: Olivia Farr
- "Other studies have found that PTSD symptoms are associated with a future risk of diabetes in a military cohort, and that present diabetes risk was higher in a community population with PTSD  . Furthermore, diabetes is worsened, as measured by increased HbA1c, with PTSD symptom severity . Altogether , these support a higher cardiometabolic risk as well as future risk for diabetes with PTSD symptomatology. "
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ABSTRACT: There is some evidence that posttraumatic stress disorder (PTSD) and early life adversity may influence metabolic outcomes such as obesity, diabetes, and cardiovascular disease. However, whether and how these interact is not clear.
We analyzed data from a cross-sectional and longitudinal study to determine how PTSD severity influences obesity, insulin sensitivity, and key measures and biomarkers of cardiovascular risk. We then looked at how PTSD and early life adversity may interact to impact these same outcomes.
PTSD severity is associated with increasing risk of obesity, diabetes, and cardiovascular disease, with higher symptoms correlating with higher values of BMI, leptin, fibrinogen, and blood pressure, and lower values of insulin sensitivity. PTSD and early life adversity have an additive effect on these metabolic outcomes. The longitudinal study confirmed findings from the cross sectional study and showed that fat mass, leptin, CRP, sICAM-1, and sTNFRII were significantly increased with higher PTSD severity during a 2.5 year follow-up period.
Individuals with early life adversity and PTSD are at high risk and should be monitored carefully for obesity, insulin resistance, and cardiometabolic risk.
Copyright © 2015 Elsevier B.V. All rights reserved.
Available from: Terence M Keane
- "Individuals with PTSD, who do not yet have diabetes, have also been found to have increased insulin resistance, suggesting future diagnoses of type 2 diabetes . Increased PTSD symptom severity appears to confer worsened type 2 diabetes, as measured by increased HbA1c . Evidence from a mouse model of PTSD suggested an adipokine-related mechanism for the decreased glucose tolerance, which was specific to PTSD . "
Available from: Ian M Kronish
- "A growing body of research also demonstrates that PTSD, in both veterans and civilians, increases the risks and consequences associated with comorbid medical conditions (Beckham et al., 1998; Jordan et al., 2011; Wisnivesky et al., 2011; Hoge et al., 2007; Jakupcak et al., 2008; Ahmadi et al., 2011; Pietrzak et al., 2012). For example, patients with PTSD are at increased risk of recurrent cardiovascular events (Edmondson et al., 2011; Shemesh et al., 2004), and among patients with diabetes, those with PTSD have poorer glycemic control and worse prognosis (Miller et al., 2011; Trief et al., 2006). The mechanisms explaining the associations between PTSD and adverse outcomes from medical illness remain poorly understood (Dedert et al., 2010). "
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Patients with post-traumatic stress disorder (PTSD) are at increased risk for adverse outcomes from comorbid medical conditions. Medication non-adherence is a potential mechanism explaining this increased risk.
We examined the association between PTSD and medication adherence in a cross-sectional study of 724 patients recruited from two Department of Veterans Affairs Medical Centers between 2008 and 2010. PTSD was assessed using the Clinician Administered PTSD Scale. Medication adherence was assessed using a standardized questionnaire. Ordinal logistic regression models were used to calculate the odds ratios (ORs) for medication non-adherence in patients with versus without PTSD, adjusting for potential confounders.
A total of 252 patients (35%) had PTSD. Twelve percent of patients with PTSD reported not taking their medications as prescribed compared to 9% of patients without PTSD (unadjusted OR 1.85, 95% CI 1.37-2.50, P<0.001). Forty-one percent of patients with PTSD compared to 29% of patients without PTSD reported forgetting medications (unadjusted OR 1.90, 95% CI 1.44-2.52, P<0.001). Patients with PTSD were also more likely to report skipping medications (24% versus 13%; unadjusted OR 2.01, 95% CI 1.44-2.82, P<0.001). The association between PTSD and non-adherence remained significant after adjusting for demographics, depression, alcohol use, social support, and medical comorbidities (adjusted OR 1.47, 95% CI 1.03-2.10, P=0.04 for not taking medications as prescribed and 1.95, 95% CI 1.31-2.91, P=0.001 for skipping medications).
PTSD was associated with medication non-adherence independent of psychiatric and medical comorbidities. Medication non-adherence may contribute to the increased morbidity and mortality observed in patients with PTSD.
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