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

Developing a multicomponent intervention to increase glucose time in range in adolescents and young adults with type 1 diabetes: An optimisation trial to screen continuous glucose monitoring, sleep extension, healthier snacking and values-guided self-management intervention components

AIM

The study aimed to identify active intervention components to improve glucose sensor time in range (TIR; 70-180 mg/dL [3.9-10.0 mmol/L]) by ≥5 % among adolescents and young adults (13 to 20 yrs) with type 1 diabetes and above recommended glycated haemoglobin (HbA1c ≥ 7.5 % [≥ 58 mmol/mol]), regardless of current insulin therapy.

METHODS

The 6-week optimisation trial used a 24 factorial experiment to estimate the main effects and interactions of the following candidate intervention components on TIR: real-time continuous glucose monitoring (CGM) technology, sleep extension, healthier snacking support, and values-guided self-management. Twenty-one participants, mean (SD) age 16.1 (2.4) years, were randomised to one of 16 experimental conditions.

RESULTS

The main effects, as measured by the mean difference (95 % CI) in TIR from baseline to 4 weeks, were: CGM, 3.3 (-8.8, 15.4) percentage points; sleep extension, -7.2 (-19.0, 4.6) percentage points; snacking support, 0.9 (-11.8, 13.5) percentage points; values-guided self-management, 6.1 (-7.5, 19.7) percentage points.

CONCLUSIONS

The values-guided self-management was the only 'active' component. Conclusions about the less impactful intervention components are limited due to disruptions in research activities from the COVID-19 pandemic. Future work will address other candidate intervention components.

Posttraumatic Stress Disorder and Type 2 Diabetes Outcomes in Veterans

Importance

Posttraumatic stress disorder (PTSD) symptom reduction is linked with lower risk of incident type 2 diabetes (T2D), but little is known about the association between PTSD and comorbid T2D outcomes. Whether PTSD is a modifiable risk factor for adverse T2D outcomes is unknown.

Objective

To determine whether patients with PTSD who improved and no longer met diagnostic criteria for PTSD had a lower risk of adverse T2D outcomes compared with patients with persistent PTSD.

Design, Setting, and Participants

This retrospective cohort study used deidentified data from US Veterans Health Administration (VHA) historical medical records (from October 1, 2011, to September 30, 2022) to create a cohort of patients aged 18 to 80 years with comorbid PTSD and T2D. Data analysis was performed from March 1 to June 1, 2024.

Exposures

Diagnoses of PTSD and T2D.

Main Outcomes and Measures

The main outcomes were insulin initiation, poor glycemic control, any microvascular complication, and all-cause mortality. Improvement of PTSD was defined as no longer meeting PTSD diagnostic criteria, per a PTSD Checklist score of less than 33. Entropy balancing controlled for confounding. Survival and competing risk models estimated the association between meeting PTSD criteria and T2D outcomes. Subgroup analyses examined variation by age, sex, race, PTSD severity, and comorbid depression status.

Results

The study cohort included 10 002 veterans. More than half of patients (65.3%) were aged older than 50 years and most (87.2%) were men. Patients identified as Black (31.6%), White (62.7%), or other race (5.7%). Before controlling for confounding with entropy balancing, patients who no longer met PTSD diagnostic criteria had similar incidence rates for starting insulin (22.4 vs 24.4 per 1000 person-years), poor glycemic control (137.1 vs 133.7 per 1000 person-years), any microvascular complication (108.4 vs 104.8 per 1000 person-years), and all-cause mortality (11.2 vs 11.0 per 1000 person-years) compared with patients with persistent PTSD. After controlling for confounding, no longer meeting PTSD criteria was associated with a lower risk of microvascular complications (hazard ratio [HR], 0.92 [95% CI, 0.85-0.99]). Among veterans aged 18 to 49 years, no longer meeting PTSD criteria was associated with a lower risk of insulin initiation (HR, 0.69 [95% CI, 0.53-0.88]) and all-cause mortality (HR, 0.39 [95% CI, 0.19-0.83]). Among patients without depression, no longer meeting PTSD criteria was associated with a lower risk of insulin initiation (HR, 0.73 [95% CI, 0.55-0.97]).

Conclusions and Relevance

The findings of this cohort study of patients with comorbid PTSD and T2D suggest that PTSD is a modifiable risk factor associated with a modest reduction in microvascular complications. Further research is needed to determine whether findings are similar in non-VHA health care settings.

Roles and competencies of the clinical psychologist in adult diabetes care-A consensus report

AIMS

Psychological care is recognised as an integral part of quality diabetes care. We set out to describe the roles and competencies of the clinical psychologist as a member of the multidisciplinary adult diabetes care team, focused on secondary care.

METHODS

The authors are clinically experienced psychologists involved in adult diabetes care, from Australia, Europe and North America, and active members of the international psychosocial aspects of diabetes study group. Consensus was reached as a group on the roles and competencies of the clinical psychologist working in adult diabetes secondary care, building both on expert opinion and a selective review and discussion of the literature on psychological care in diabetes, clinical guidelines and competency frameworks.

RESULTS

The clinical psychologist fulfils multiple roles: (1) as a clinician (psychological assessment and therapy), (2) as advisor to the healthcare team (training, consulting), (3) as a communicator and promotor of person-centred care initiatives and (4) as a researcher. Four competencies that are key to successfully fulfilling the above-mentioned roles in a diabetes setting are as follows: (a) specialised knowledge, (b) teamwork and advice, (c) assessment, (d) psychotherapy (referred to as STAP framework).

CONCLUSIONS

The roles and competencies of clinical psychologists working in diabetes extend beyond the requirements of most university and post-graduate curricula. There is a need for a comprehensive, accredited specialist post-graduate training for clinical psychologists working in diabetes care, building on the proposed STAP framework. This calls for a collaborative effort involving diabetes organisations, clinical psychology societies and diabetes psychology interest groups.

Diabetes-Related Posttraumatic Stress Symptoms in Adolescents and Young Adults With Type 1 Diabetes: A Pilot Study

BACKGROUND

Posttraumatic stress symptoms (PTSS) may adversely affect glycemic control. Yet no studies have focused on trauma and PTSS induced by diabetes-related events in adolescents and young adults (AYA) with type 1 diabetes.

OBJECTIVE

This study explores PTSS arising from diabetes-related events (e.g., severe symptoms or emergency room visits due to complications) among AYA with type 1 diabetes.

METHODS

In this cross-sectional pilot study, self-reported measures (Posttraumatic Diagnostic Scale for DSM-5, Child Posttraumatic Stress Disorder Symptom Scale 5) were employed to assess trauma experiences and PTSS in AYA with type 1 diabetes at a pediatric diabetes clinic within a large hospital/academic medical center.

RESULTS

Fifty AYA with type 1 diabetes completed questionnaires assessing trauma and PTSS. Of the sample, 82% (n = 41) reported experiencing at least one form of general trauma (e.g., physical abuse, witnessing violence, or serious injuries). Among those who reported trauma, 22% (n = 9) indicated that the most distressing event was specifically diabetes-related. Over a quarter of participants exhibited clinically relevant levels of PTSS related to diabetes events. Females assigned at birth and those with a higher frequency of emergency room visits due to diabetes had an elevated risk of developing clinically relevant levels of diabetes-related PTSS.

CONCLUSIONS

Our results suggest that diabetes itself can serve as a traumatic stressor for some individuals. Therefore, interventions should be designed to prevent or mitigate PTSS starting from the time of diagnosis.