CHRONIC DISEASE: Posttraumatic stress disorder (PTSD) associated with elevated hemoglobin A1c levels in low-income blacks with diabetesThe frequency of posttraumatic stress disorder (PTSD) ranges from 10 to more than 50 percent in urban primary care settings where the prevalence of trauma is high. There is also growing evidence that PTSD is linked with chronic disease, such as diabetes and heart disease, and with poorer health outcomes. In fact, a recent study found that PTSD was significantly associated with a hemoglobin (Hb) A1c level (a marker of diabetes control) greater than 7 percent among low-income minorities. The researchers recruited men and women with type 2 diabetes from four community-based primary care clinics in Harlem, New York City. In addition to demographic information, participants were screened for depressive symptoms and for lifetime PTSD. A total of 103 adults were included in the final analysis. Within the group, 12 percent had lifetime full PTSD, while another 12 percent had sub-threshold PTSD. Those with lifetime PTSD were significantly more likely to have an HbA1c level of greater than 7 percent compared to patients not experiencing PTSD symptoms.
The most common sources of trauma were childhood physical abuse (22 percent) and the death of a child (18 percent). Patients with PTSD were also more likely to suffer from depressive symptoms and to be taking a psychiatric medication. In addition to PTSD, patients with HbA1c levels above 7 percent had diabetes for 15 or more years and were more likely to be taking insulin. The researchers encourage physicians to consider a diagnosis of PTSD in low-income patients with diabetes who are experiencing poor glucose control. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00066).
See "Associations between posttraumatic stress disorder and hemoglobin A1c in low-income minority patients with diabetes," by Samantha A. Miller, M.D., M.S., Carol A. Mancuso, M.D., Carla Boutin-Foster, M.D., M.S., and others in General Hospital Psychiatry 33, pp. 116-122, 2011.