Posttraumatic stress disorder and diabetes-related outcomes in patients with type 1 diabetes

doi:10.1038/s41598-023-28373-x

. 2023 Jan 27;13(1):1556.

doi: 10.1038/s41598-023-28373-x.

Posttraumatic stress disorder and diabetes-related outcomes in patients with type 1 diabetes

Frederike Lunkenheimer¹, Alexander J Eckert^{2

3}, Dörte Hilgard⁴, Daniel Köth⁵, Bernhard Kulzer^{3

6}, Ursula Lück⁷, Blanca Lüdecke⁸, Antonia Müller⁹, Harald Baumeister¹⁰, Reinhard W Holl^{2

3}

Affiliations

¹ Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany. frederike.lunkenheimer@uni-ulm.de.
² Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, Ulm, Germany.
³ German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, Munich-Neuherberg, Germany.
⁴ Pediatric Endocrinology and Diabetology, Primary Psychosomatic Care, Bahnhofstraße 54, Witten, Germany.
⁵ Department of Endocrinology and Diabetology, Hospital Sachsenhausen, Schulstraße 31, Frankfurt, Germany.
⁶ Research Institute of the Diabetes-Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Straße 12, Bad Mergentheim, Germany.
⁷ Department of Pediatrics and Adolescent Medicine, Regional Hospital Mödling, Sr. M. Restituta-Gasse 12, Mödling, Austria.
⁸ Diabetes Centre, Alexianer St. Hedwig Hospital, Große Hambuger Straße 5-11, Berlin, Germany.
⁹ Clinic Group Dr. Guth GmbH & Co. KG, Clinical Center Karlsburg, Greifswalder Straße 11, Karlsburg, Germany.
¹⁰ Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany.

PMID: 36707607
DOI: 10.1038/s41598-023-28373-x

Posttraumatic stress disorder and diabetes-related outcomes in patients with type 1 diabetes

Frederike Lunkenheimer et al. Sci Rep. 2023.

. 2023 Jan 27;13(1):1556.

doi: 10.1038/s41598-023-28373-x.

Authors

Affiliations

¹ Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany. frederike.lunkenheimer@uni-ulm.de.
² Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, Ulm, Germany.
³ German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, Munich-Neuherberg, Germany.
⁴ Pediatric Endocrinology and Diabetology, Primary Psychosomatic Care, Bahnhofstraße 54, Witten, Germany.
⁵ Department of Endocrinology and Diabetology, Hospital Sachsenhausen, Schulstraße 31, Frankfurt, Germany.
⁶ Research Institute of the Diabetes-Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Straße 12, Bad Mergentheim, Germany.
⁷ Department of Pediatrics and Adolescent Medicine, Regional Hospital Mödling, Sr. M. Restituta-Gasse 12, Mödling, Austria.
⁸ Diabetes Centre, Alexianer St. Hedwig Hospital, Große Hambuger Straße 5-11, Berlin, Germany.
⁹ Clinic Group Dr. Guth GmbH & Co. KG, Clinical Center Karlsburg, Greifswalder Straße 11, Karlsburg, Germany.
¹⁰ Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany.

PMID: 36707607
DOI: 10.1038/s41598-023-28373-x

Abstract

Mental comorbidities in patients with type 1 diabetes mellitus (T1D) are common, and can have a negative impact on acute blood glucose levels and long-term metabolic control. Information on the association of T1D and comorbid posttraumatic stress disorder (PTSD) with diabetes-related outcomes is limited. The aim was to examine the associations between a clinical diagnosis of PTSD and diabetes-related outcomes in patients with T1D. Patients with T1D and comorbid documented PTSD from the DPV database (n = 179) were compared to a group with T1D without PTSD (n = 895), and compared to a group with T1D without comorbid mental disorder (n = 895) by matching demographics (age, gender, duration of diabetes, therapy and migration background) 1:5. Clinical diabetes-related outcomes {body mass index (BMI), hemoglobin A1c (hbA1c), daily insulin dose, diabetic ketoacidosis (DKA), hypoglycemia, number of hospital admissions, number of hospital days} were analyzed, stratified by age groups (≤ 25 years vs. > 25 years). Patients with comorbid PTSD aged ≤ 25 years compared with patients without PTSD or patients without mental disorders had significantly higher HbA1c (8.71 vs. 8.30 or 8.24%), higher number of hospital admissions (0.94 vs. 0.44 or 0.32 per year) and higher rates of DKA (0.10 vs. 0.02 or 0.01 events/year). Patients with comorbid PTSD aged ≤ 25 years compared with patients without PTSD had significantly higher BMI (0.85 vs. 0.59) and longer hospital stays (15.89 vs.11.58 days) than patients without PTSD. Patients with PTSD > 25 years compared with patients without PTSD or without any mental comorbidities had significantly fewer hospital admissions (0.49 vs. 0.77 or 0.69), but a longer hospital length of stay (20.35 vs. 11.58 or 1.09 days). We found that PTSD in younger patients with T1D is significantly related to diabetes outcome. In adult patients with T1D, comorbid PTSD is associated with fewer, but longer hospitalizations. Awareness of PTSD in the care of patients with T1D should be raised and psychological intervention should be provided when necessary.

References

1. Cooper, M. N. et al. Psychiatric disorders during early adulthood in those with childhood onset type 1 diabetes: Rates and clinical risk factors from population-based follow-up. Pediatr. Diabetes 18, 599–606 (2017).
1. Lin Elizabeth, H. B. & Von Korff, M. Mental disorders among persons with diabetes—results from the World Mental Health Surveys. J. Psychosom. Res. 65, 571–580 (2008).
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013).
1. Koenen, K. C. et al. Posttraumatic stress disorder in the World Mental Health Surveys. Psychol. Med. 47, 2260–2274 (2017).
1. Landolt, M. A., Ystrom, E., Sennhauser, F. H., Gnehm, H. E. & Vollrath, M. E. The mutual prospective influence of child and parental post-traumatic stress symptoms in pediatric patients. J. Child Psychol. Psychiatry Allied Discip. 53, 767–774 (2012).

Grant support

[1] Cooper, M. N. et al. Psychiatric disorders during early adulthood in those with childhood onset type 1 diabetes: Rates and clinical risk factors from population-based follow-up. Pediatr. Diabetes 18, 599–606 (2017).

[2] Cooper, M. N. et al. Psychiatric disorders during early adulthood in those with childhood onset type 1 diabetes: Rates and clinical risk factors from population-based follow-up. Pediatr. Diabetes 18, 599–606 (2017).

[3] Lin Elizabeth, H. B. & Von Korff, M. Mental disorders among persons with diabetes—results from the World Mental Health Surveys. J. Psychosom. Res. 65, 571–580 (2008).

[4] Lin Elizabeth, H. B. & Von Korff, M. Mental disorders among persons with diabetes—results from the World Mental Health Surveys. J. Psychosom. Res. 65, 571–580 (2008).

[5] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013).

[6] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013).

[7] Koenen, K. C. et al. Posttraumatic stress disorder in the World Mental Health Surveys. Psychol. Med. 47, 2260–2274 (2017).

[8] Koenen, K. C. et al. Posttraumatic stress disorder in the World Mental Health Surveys. Psychol. Med. 47, 2260–2274 (2017).

[9] Landolt, M. A., Ystrom, E., Sennhauser, F. H., Gnehm, H. E. & Vollrath, M. E. The mutual prospective influence of child and parental post-traumatic stress symptoms in pediatric patients. J. Child Psychol. Psychiatry Allied Discip. 53, 767–774 (2012).

[10] Landolt, M. A., Ystrom, E., Sennhauser, F. H., Gnehm, H. E. & Vollrath, M. E. The mutual prospective influence of child and parental post-traumatic stress symptoms in pediatric patients. J. Child Psychol. Psychiatry Allied Discip. 53, 767–774 (2012).