PDF(Pubmed)
Abstract：
UNASSIGNED: Posttraumatic stress disorder (PTSD) symptom reduction is linked with lower risk of incident type 2 diabetes (T2D), but little is known about the association between PTSD and comorbid T2D outcomes. Whether PTSD is a modifiable risk factor for adverse T2D outcomes is unknown.
UNASSIGNED: To determine whether patients with PTSD who improved and no longer met diagnostic criteria for PTSD had a lower risk of adverse T2D outcomes compared with patients with persistent PTSD.
UNASSIGNED: This retrospective cohort study used deidentified data from US Veterans Health Administration (VHA) historical medical records (from October 1, 2011, to September 30, 2022) to create a cohort of patients aged 18 to 80 years with comorbid PTSD and T2D. Data analysis was performed from March 1 to June 1, 2024.
UNASSIGNED: Diagnoses of PTSD and T2D.
UNASSIGNED: The main outcomes were insulin initiation, poor glycemic control, any microvascular complication, and all-cause mortality. Improvement of PTSD was defined as no longer meeting PTSD diagnostic criteria, per a PTSD Checklist score of less than 33. Entropy balancing controlled for confounding. Survival and competing risk models estimated the association between meeting PTSD criteria and T2D outcomes. Subgroup analyses examined variation by age, sex, race, PTSD severity, and comorbid depression status.
UNASSIGNED: The study cohort included 10 002 veterans. More than half of patients (65.3%) were aged older than 50 years and most (87.2%) were men. Patients identified as Black (31.6%), White (62.7%), or other race (5.7%). Before controlling for confounding with entropy balancing, patients who no longer met PTSD diagnostic criteria had similar incidence rates for starting insulin (22.4 vs 24.4 per 1000 person-years), poor glycemic control (137.1 vs 133.7 per 1000 person-years), any microvascular complication (108.4 vs 104.8 per 1000 person-years), and all-cause mortality (11.2 vs 11.0 per 1000 person-years) compared with patients with persistent PTSD. After controlling for confounding, no longer meeting PTSD criteria was associated with a lower risk of microvascular complications (hazard ratio [HR], 0.92 [95% CI, 0.85-0.99]). Among veterans aged 18 to 49 years, no longer meeting PTSD criteria was associated with a lower risk of insulin initiation (HR, 0.69 [95% CI, 0.53-0.88]) and all-cause mortality (HR, 0.39 [95% CI, 0.19-0.83]). Among patients without depression, no longer meeting PTSD criteria was associated with a lower risk of insulin initiation (HR, 0.73 [95% CI, 0.55-0.97]).
UNASSIGNED: The findings of this cohort study of patients with comorbid PTSD and T2D suggest that PTSD is a modifiable risk factor associated with a modest reduction in microvascular complications. Further research is needed to determine whether findings are similar in non-VHA health care settings.
UNASSIGNED: To determine whether patients with PTSD who improved and no longer met diagnostic criteria for PTSD had a lower risk of adverse T2D outcomes compared with patients with persistent PTSD.
UNASSIGNED: This retrospective cohort study used deidentified data from US Veterans Health Administration (VHA) historical medical records (from October 1, 2011, to September 30, 2022) to create a cohort of patients aged 18 to 80 years with comorbid PTSD and T2D. Data analysis was performed from March 1 to June 1, 2024.
UNASSIGNED: Diagnoses of PTSD and T2D.
UNASSIGNED: The main outcomes were insulin initiation, poor glycemic control, any microvascular complication, and all-cause mortality. Improvement of PTSD was defined as no longer meeting PTSD diagnostic criteria, per a PTSD Checklist score of less than 33. Entropy balancing controlled for confounding. Survival and competing risk models estimated the association between meeting PTSD criteria and T2D outcomes. Subgroup analyses examined variation by age, sex, race, PTSD severity, and comorbid depression status.
UNASSIGNED: The study cohort included 10 002 veterans. More than half of patients (65.3%) were aged older than 50 years and most (87.2%) were men. Patients identified as Black (31.6%), White (62.7%), or other race (5.7%). Before controlling for confounding with entropy balancing, patients who no longer met PTSD diagnostic criteria had similar incidence rates for starting insulin (22.4 vs 24.4 per 1000 person-years), poor glycemic control (137.1 vs 133.7 per 1000 person-years), any microvascular complication (108.4 vs 104.8 per 1000 person-years), and all-cause mortality (11.2 vs 11.0 per 1000 person-years) compared with patients with persistent PTSD. After controlling for confounding, no longer meeting PTSD criteria was associated with a lower risk of microvascular complications (hazard ratio [HR], 0.92 [95% CI, 0.85-0.99]). Among veterans aged 18 to 49 years, no longer meeting PTSD criteria was associated with a lower risk of insulin initiation (HR, 0.69 [95% CI, 0.53-0.88]) and all-cause mortality (HR, 0.39 [95% CI, 0.19-0.83]). Among patients without depression, no longer meeting PTSD criteria was associated with a lower risk of insulin initiation (HR, 0.73 [95% CI, 0.55-0.97]).
UNASSIGNED: The findings of this cohort study of patients with comorbid PTSD and T2D suggest that PTSD is a modifiable risk factor associated with a modest reduction in microvascular complications. Further research is needed to determine whether findings are similar in non-VHA health care settings.
摘要：
创伤后应激障碍(PTSD)症状减轻与2型糖尿病(T2D)发病风险降低有关。但对PTSD与T2D合并症结局之间的关联知之甚少。PTSD是否是T2D不良结局的可改变的危险因素尚不清楚。
■确定改善且不再符合PTSD诊断标准的PTSD患者与持续性PTSD患者相比是否具有较低的不良T2D结局风险。
■这项回顾性队列研究使用了来自美国退伍军人健康管理局（VHA）历史医疗记录（2011年10月1日至2022年9月30日）的未识别数据，以创建一个18至80岁的患者队列患有PTSD和T2D。从2024年3月1日至6月1日进行数据分析。
■PTSD和T2D的诊断。
■主要结果是胰岛素启动，血糖控制不佳,任何微血管并发症，和全因死亡率。PTSD的改善被定义为不再符合PTSD诊断标准，根据创伤后应激障碍检查表得分低于33分。熵平衡控制混杂。生存和竞争风险模型估计了满足PTSD标准和T2D结果之间的关联。亚组分析检查了按年龄划分的变异，性别,种族,创伤后应激障碍严重程度,和共病抑郁状态。
■该研究队列包括10002名退伍军人。超过一半的患者（65.3％）年龄在50岁以上，大多数（87.2％）是男性。确定为黑人的患者（31.6％），白色（62.7%），或其他种族(5.7%)。在控制与熵平衡混淆之前，不再符合PTSD诊断标准的患者开始胰岛素的发生率相似（22.4vs24.4/1000人年），血糖控制不佳（每1000人年137.1比133.7），任何微血管并发症（108.4vs104.8/1000人年），和全因死亡率（每1000人年11.2vs11.0）与持续性PTSD患者相比。在控制了混淆之后，不再符合PTSD标准与微血管并发症的风险较低相关(风险比[HR]，0.92[95%CI，0.85-0.99]）。在18至49岁的退伍军人中，不再符合PTSD标准与胰岛素启动风险较低相关(HR，0.69[95%CI，0.53-0.88])和全因死亡率(HR，0.39[95%CI，0.19-0.83]）。在没有抑郁症的患者中，不再符合PTSD标准与胰岛素启动风险较低相关(HR，0.73[95%CI，0.55-0.97]）。
■这项针对PTSD和T2D合并症患者的队列研究结果表明，PTSD是一个可改变的危险因素，与微血管并发症的适度减少有关。需要进一步的研究来确定在非VHA医疗保健环境中的发现是否相似。
■确定改善且不再符合PTSD诊断标准的PTSD患者与持续性PTSD患者相比是否具有较低的不良T2D结局风险。
■这项回顾性队列研究使用了来自美国退伍军人健康管理局（VHA）历史医疗记录（2011年10月1日至2022年9月30日）的未识别数据，以创建一个18至80岁的患者队列患有PTSD和T2D。从2024年3月1日至6月1日进行数据分析。
■PTSD和T2D的诊断。
■主要结果是胰岛素启动，血糖控制不佳,任何微血管并发症，和全因死亡率。PTSD的改善被定义为不再符合PTSD诊断标准，根据创伤后应激障碍检查表得分低于33分。熵平衡控制混杂。生存和竞争风险模型估计了满足PTSD标准和T2D结果之间的关联。亚组分析检查了按年龄划分的变异，性别,种族,创伤后应激障碍严重程度,和共病抑郁状态。
■该研究队列包括10002名退伍军人。超过一半的患者（65.3％）年龄在50岁以上，大多数（87.2％）是男性。确定为黑人的患者（31.6％），白色（62.7%），或其他种族(5.7%)。在控制与熵平衡混淆之前，不再符合PTSD诊断标准的患者开始胰岛素的发生率相似（22.4vs24.4/1000人年），血糖控制不佳（每1000人年137.1比133.7），任何微血管并发症（108.4vs104.8/1000人年），和全因死亡率（每1000人年11.2vs11.0）与持续性PTSD患者相比。在控制了混淆之后，不再符合PTSD标准与微血管并发症的风险较低相关(风险比[HR]，0.92[95%CI，0.85-0.99]）。在18至49岁的退伍军人中，不再符合PTSD标准与胰岛素启动风险较低相关(HR，0.69[95%CI，0.53-0.88])和全因死亡率(HR，0.39[95%CI，0.19-0.83]）。在没有抑郁症的患者中，不再符合PTSD标准与胰岛素启动风险较低相关(HR，0.73[95%CI，0.55-0.97]）。
■这项针对PTSD和T2D合并症患者的队列研究结果表明，PTSD是一个可改变的危险因素，与微血管并发症的适度减少有关。需要进一步的研究来确定在非VHA医疗保健环境中的发现是否相似。
