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J Psychiatr Res. 2014 Sep;56:158-64. doi: 10.1016/j.jpsychires.2014.05.019. Epub 2014 Jun 9.

Posttraumatic stress disorder and incidence of type-2 diabetes: a prospective twin study.

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Department of Epidemiology, Emory University, Atlanta, GA, United States. Electronic address:
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.
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.
Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, United States.
VA National Center for PTSD, White River Junction VA Medical Center, White River Junction, VT, United States.
VA Boston Healthcare System, Boston, MA, United States; Boston University, Boston, MA, United States.
Department of Biostatistics, University of Washington, Seattle, WA, United States.
Cooperative Studies Program, Clinical Science Research and Development, VA Office of Research and Development, Washington, DC, United States.


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.


Diabetes; Epidemiology; Posttraumatic stress disorder; Stress; Twin studies

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