title: Posttraumatic stress disorder and incidence of type-2 diabetes: a prospective twin study.
abstract: Growing evidence has linked posttraumatic stress disorder (PTSD) to insulin resistance and type-2 diabetes, but most previous studies were cross-sectional. We examined the association between PTSD and incidence of diabetes in a prospective study of middle-aged male twins from the Vietnam Era Twin Registry. Lifetime PTSD was diagnosed at baseline with the Diagnostic Interview Schedule (DIS) according to DSM-III-R criteria. Subthreshold PTSD was defined by meeting some, but not all, criteria for PTSD. A total of 4340 respondents without self-reported diabetes at baseline were included. Of these, 658 reported a new diagnosis of treated diabetes over a median of 19.4 years of follow-up. At baseline, twins with PTSD showed more behavioral and metabolic risk factors such as overweight and hypertension. The age-adjusted cumulative incidence of diabetes was significantly higher in twins with PTSD (18.9%) than those without PTSD (14.4%), [odds ratio (OR) = 1.4, 95% confidence interval (CI) 1.03-1.8], and intermediate in those with subthreshold PTSD (16.4%) (OR = 1.2, 95% CI 0.9-1.5, p for trend = 0.03). Adjustment for military, lifestyle and metabolic factors diminished the association. No significant association was found comparing twin pairs discordant for PTSD. In conclusion, PTSD was prospectively associated with a 40% increased risk of new-onset type-2 diabetes which was partially explained by a cluster of metabolic and behavioral risk factors known to influence insulin resistance. Shared biological or behavioral precursors which occur within families may lead to both PTSD and insulin resistance/diabetes. Thus, PTSD could be a marker of neuroendocrine and metabolic dysregulation which may lead to type-2 diabetes.
authors.affiliation: Department of Epidemiology, Emory University, Atlanta, GA, United States. Electronic address: viola.vaccarino@emory.edu.
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.affiliation: Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, United States; Department of Epidemiology, University of Washington, Seattle, WA, United States.
authors.forename: Jack
authors.initials: J
authors.lastname: Goldberg
authors.affiliation: Ralph H. Johnson VA Medical Center, Charleston, SC, United States; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Magruder
authors.affiliation: Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, United States.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Forsberg
authors.affiliation: VA National Center for PTSD, White River Junction VA Medical Center, White River Junction, VT, United States.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Friedman
authors.affiliation: VA Boston Healthcare System, Boston, MA, United States; Boston University, Boston, MA, United States.
authors.forename: Brett T
authors.initials: BT
authors.lastname: Litz
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA, United States.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Heagerty
authors.affiliation: Cooperative Studies Program, Clinical Science Research and Development, VA Office of Research and Development, Washington, DC, United States.
authors.forename: Grant D
authors.initials: GD
authors.lastname: Huang
authors.affiliation: Cooperative Studies Program, Clinical Science Research and Development, VA Office of Research and Development, Washington, DC, United States.
authors.forename: Theresa C
authors.initials: TC
authors.lastname: Gleason
authors.affiliation: Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, United States; Department of Epidemiology, University of Washington, Seattle, WA, United States.
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Smith
mesh_terms: D000328:Adult; D000367:Age Factors; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D008889:Military Personnel; D011446:Prospective Studies; D012042:Registries; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000503:physiopathology; D014728:Veterans
keywords: Diabetes; Epidemiology; Posttraumatic stress disorder; Stress; Twin studies