title: Hyperinsulinemic response to oral glucose challenge in individuals with posttraumatic stress disorder.
abstract: BACKGROUND
  Posttraumatic stress disorder (PTSD) is associated with a 2-4 fold increased risk of developing Type 2 diabetes mellitus. However, detailed assessments of glucose metabolism and insulin secretion in a study designed to minimize confounders are lacking. Furthermore, few studies examine potential mechanisms involved. We analyzed data from a case-control study of medically healthy, medication-free adults to determine whether individuals with PTSD had abnormal glucose or insulin response to oral glucose tolerance test (OGTT) compared to controls. Secondarily, we assessed potential mediators such as sleep, cortisol and adiponectin.
  
  
  METHODS
  Data was analyzed from 92 age and gender-matched subjects (44 PTSD, 48 controls). Chronic PTSD was diagnosed using the Structured Clinical Interview for DSM-IV and Clinician Administered PTSD Scale. Subjects underwent 75-g OGTT, actigraphy and sleep diary (to quantify sleep duration), polysomnography (to assess slow wave sleep [SWS] and delta power), and overnight blood sampling (for cortisol and adiponectin).
  
  
  RESULTS
  At baseline, individuals with PTSD had mildly increased insulin levels (by 19%, compared to controls, p=0.048) that was mediated primarily by weight. In response to OGTT, the PTSD group had higher levels of insulin at 120 min (by 44%, p=0.03) and insulin AUC (by 43%, p=0.015) compared to controls, after adjusting for confounders. Glucose levels were similar in the two groups. Although self-reported sleep duration, SWS, and delta power differed between PTSD subjects and controls, they did not mediate the effects of PTSD status on insulin response.
  
  
  CONCLUSIONS
  In this case-control study, individuals with PTSD had a hyperinsulinemic response to oral glucose challenge compared to controls, suggestive of insulin resistance.
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Francisco, CA, USA. Electronic address: Madhu.Rao@usf.edu.
authors.forename: Madhu N
authors.initials: MN
authors.lastname: Rao
authors.affiliation: Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: Alanna
authors.initials: A
authors.lastname: Chau
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Northern California Institute for Research and Education, San Francisco, CA, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Madden
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA.
authors.forename: Sabra
authors.initials: S
authors.lastname: Inslicht
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Talbot
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Richards
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA.
authors.forename: Aoife
authors.initials: A
authors.lastname: O'Donovan
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Ruoff
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Francisco, CA, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Grunfeld
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
mesh_terms: D056044:Actigraphy; D052242:Adiponectin / Q000097:blood*; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D006946:Hyperinsulinism / Q000097:blood*; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012890:Sleep / Q000187:drug effects / Q000502:physiology; D013313:Stress Disorders, Post-Traumatic / Q000097:blood / Q000378:metabolism* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D052242:Adiponectin; D001786:Blood Glucose; D006854:Hydrocortisone
keywords: Adipocytokines; Diabetes mellitus; Glucose metabolism; Hyperinsulinemia; Insulin resistance; Oral glucose tolerance test; Posttraumatic stress disorder; Sleep
references.citation: Obesity (Silver Spring). 2012 Jan;20(1):200-5
references.pmid: 22016096
references.citation: Prog Neuropsychopharmacol Biol Psychiatry. 2007 May 9;31(4):839-47
references.pmid: 17328999
references.citation: Psychosom Med. 2001 Nov-Dec;63(6):966-72
references.pmid: 11719636
references.citation: Biol Psychiatry. 2011 Sep 1;70(5):465-71
references.pmid: 21489410
references.citation: Lancet. 2003 Jan 18;361(9353):226-8
references.pmid: 12547549
references.citation: Depress Anxiety. 2001;13(3):132-56
references.pmid: 11387733
references.citation: Sleep. 1995 Jul;18(6):463-9
references.pmid: 7481418
references.citation: J Natl Med Assoc. 2007 Jun;99(6):642-9
references.pmid: 17595933
references.citation: Diabetes. 2001 May;50(5):1126-33
references.pmid: 11334417
references.citation: Menopause. 2004 Mar-Apr;11(2):198-207
references.pmid: 15021450
references.citation: J Biol Chem. 1996 May 3;271(18):10697-703
references.pmid: 8631877
references.citation: Psychiatry Clin Neurosci. 2001 Jun;55(3):305-10
references.pmid: 11422885
references.citation: J Clin Endocrinol Metab. 1982 Jan;54(1):131-8
references.pmid: 7033265
references.citation: J Sleep Res. 2013 Dec;22(6):679-87
references.pmid: 23763708
references.citation: Proc Natl Acad Sci U S A. 2008 Jan 22;105(3):1044-9
references.pmid: 18172212
references.citation: Diabetologia. 2011 Apr;54(4):900-9
references.pmid: 21181395
references.citation: Psychiatr Serv. 2002 Jul;53(7):848-54
references.pmid: 12096168
references.citation: J Clin Endocrinol Metab. 2003 Jun;88(6):2399-403
references.pmid: 12788834
references.citation: Am J Addict. 2005 Mar-Apr;14(2):106-23
references.pmid: 16019961
references.citation: Ann N Y Acad Sci. 2004 Dec;1032:141-53
references.pmid: 15677401
references.citation: J Nerv Ment Dis. 1990 Jun;178(6):366-9
references.pmid: 2348190
references.citation: Metabolism. 2003 Oct;52(10):1274-8
references.pmid: 14564678
references.citation: PLoS One. 2013 Sep 27;8(9):e75205
references.pmid: 24228086
references.citation: Eur Heart J. 2011 Mar;32(6):730-6
references.pmid: 20971746
references.citation: Eur J Public Health. 2012 Oct;22(5):658-62
references.pmid: 21953061
references.citation: Arch Gen Psychiatry. 2005 Jun;62(6):617-27
references.pmid: 15939839
references.citation: J Psychosom Res. 2013 Apr;74(4):340-5
references.pmid: 23497837
references.citation: Lancet. 1999 Oct 23;354(9188):1435-9
references.pmid: 10543671
references.citation: Biochem J. 2008 Feb 1;409(3):623-33
references.pmid: 18177270
references.citation: J Psychosom Res. 2008 Jan;64(1):33-40
references.pmid: 18157997
references.citation: Physiol Rev. 1995 Jul;75(3):473-86
references.pmid: 7624391
references.citation: J Clin Invest. 2006 Jul;116(7):1784-92
references.pmid: 16823476
references.citation: Behav Res Methods Instrum Comput. 2004 Nov;36(4):717-31
references.pmid: 15641418
references.citation: J Pers Soc Psychol. 1986 Dec;51(6):1173-82
references.pmid: 3806354
references.citation: Diabetes Care. 2010 Aug;33(8):1771-7
references.pmid: 20484134
references.citation: Arch Intern Med. 2005 Apr 25;165(8):863-7
references.pmid: 15851636
references.citation: Gen Hosp Psychiatry. 2011 Mar-Apr;33(2):135-42
references.pmid: 21596206
references.citation: J Clin Invest. 1993 Nov;92(5):2283-90
references.pmid: 8227343
references.citation: BMC Med. 2009 Jan 09;7:1
references.pmid: 19134183
references.citation: Lancet. 1998 Mar 21;351(9106):867-70
references.pmid: 9525364
references.citation: Diabetes Care. 2003 Dec;26(12):3226-9
references.pmid: 14633806
references.citation: Biol Psychiatry. 2001 Dec 15;50(12):965-77
references.pmid: 11750893
references.citation: Diabetes Care. 1999 Sep;22(9):1462-70
references.pmid: 10480510
references.citation: Lancet. 2002 Jul 6;360(9326):57-8
references.pmid: 12114044
references.citation: Epidemiology. 2008 Nov;19(6):838-45
references.pmid: 18854708
references.citation: Psychosom Med. 2009 Nov;71(9):1012-7
references.pmid: 19834051
references.citation: J Trauma Stress. 2006 Aug;19(4):461-70
references.pmid: 16929502
references.citation: Clin Sci (Lond). 2006 Mar;110(3):267-78
references.pmid: 16464169
references.citation: J Clin Endocrinol Metab. 2004 Jan;89(1):87-90
references.pmid: 14715832
references.citation: Diabetes Obes Metab. 2007 May;9(3):282-9
references.pmid: 17391153
references.citation: Diabetologia. 1985 Jul;28(7):412-9
references.pmid: 3899825
references.citation: Prev Med. 2005 May;40(5):570-4
references.pmid: 15749140
references.citation: J Trauma Stress. 1995 Jan;8(1):75-90
references.pmid: 7712061
references.citation: J Behav Med. 2006 Oct;29(5):411-8
references.pmid: 16865552
references.citation: Psychosom Med. 2011 Oct;73(8):697-707
references.pmid: 21949429
references.citation: Biol Psychiatry. 1990 Jan 15;27(2):245-7
references.pmid: 2294983
references.citation: Curr Diab Rep. 2003 Jun;3(3):207-13
references.pmid: 12762967