Comorbid PTSD May Be Linked to Worse T1D Outcomes

In younger people with type 1 diabetes (T1D), post-traumatic stress disorder (PTSD) was significantly related to T1D outcomes in a study published in Scientific Reports.

According to the study authors, mental comorbidities—including anxiety, eating, mood, personality, and behavior disorders—in patients with T1D are common and can negatively affect acute blood glucose levels and long‐term metabolic control. However, information on how T1D and comorbid PTSD are linked to T1D outcomes is limited.

To assess this link, the authors compared 179 patients with T1D and diagnosed comorbid PTSD to 895 patients with T1D without PTSD, as well as to 895 patients with T1D without any comorbid mental disorder. Patients in the first group were matched 1:5 to the other groups by age, gender, T1D duration, therapy, and migration background. These data were pulled from the German diabetes follow-up registry, Diabetes-Patienten-Verlaufsdokumentation (DPV).

The authors also analyzed clinical T1D-associated outcomes, including body mass index (BMI), hemoglobin A_1C (HbA_1C), daily insulin dose, diabetic ketoacidosis (DKA), hypoglycemia, number of hospital admissions, and length of hospital stay. Results were further stratified by age group: 25 years and younger and older than 25 years.

Patients with comorbid PTSD aged 25 and younger experienced the following outcomes, on average, compared with patients in the same age group without comorbid PTSD or without a comorbid mental disorder, respectively:

• Significantly higher HbA_1C: 8.71% vs 8.30% or 8.24%
• Higher number of hospital admissions: 0.94 vs 0.44 or 0.32/year
• Higher rates of DKA: 0.10 vs 0.02 or 0.01 events/year

The study also demonstrated that patients with PTSD in this age group had significantly higher BMI (0.85 vs 0.59) and longer hospital stays (15.89 vs 11.58 days) compared with patients without PTSD.

Some results differed for patients aged older than 25 years. Patients in this older age group with comorbid PTSD experienced significantly fewer hospital admissions with a mean of 0.49 admissions per year compared with 0.77 admissions for patients without PTSD and 0.69 for patients with no mental comorbidity.

However, hospital length of stay was significantly longer for these patients, with a mean of 20.35 days for patients with PTSD, 11.58 days for patients without PTSD, and 1.09 days for patients with no mental comorbidity.

According to the authors, longer hospitalizations for these patients—when DKA is not the cause for hospitalization—may be partially due to the type of institution. They noted that the average inpatient stay for psychiatric or psychotherapeutic treatment for mental comorbidities is significantly longer than that for the treatment of a patient with T1D, at 25 vs 7 days.

“As psychotherapeutic interventions to improve treatment adherence or reduce symptoms of comorbid mental disorders (such as depression) may have a positive effect on HbA_1C levels in addition to the primary treatment goal, it is possible that patients with T1D and PTSD may even have a positive impact on T1D disease progression, such as the number of hospital admissions, as a result of treatment for the comorbid mental disorder compared to patients without psychological support,” the authors said.

No significant differences regarding daily insulin dosage or hypoglycemia were noted.

The authors emphasized these findings do not mean there is a causal relationship between PTSD and T1D-related outcomes, but that this idea should be considered in future research.

Overall, they found that younger patients with T1D and PTSD face the strongest negative impact on HbA_1C, DKA, BMI, hospital admission, and length of hospital stay.

“These consequences, in the context of the increased prevalence of PTSD in T1D compared to adolescents without T1D, point to the relevance and importance of this comorbidity in clinical practice,” the authors concluded. “It should therefore be considered to screen this at-risk group preventively for PTSD or psychological distress in routine healthcare. Early detection and psychological counseling—ideally through the early involvement of a multidisciplinary diabetes specialist team—are necessary.”

Reference

Lunkenheimer F, Eckert AJ, Hilgard D, et al. Posttraumatic stress disorder and diabetes-related outcomes in patients with type 1 diabetes. Sci Rep. 2023;13(1):1556. doi:10.1038/s41598-023-28373-x