THE IMPACT OF POST-TRAUMATIC STRESS ON GLUCOSE METABOLISM TRAJECTORIES: A HEALTH DISPARITIES APPROACH.

Abstract

Objective: Type 2 Diabetes Mellitus (T2DM), a leading cause of U.S. deaths, disproportionately impacts racial/ethnic minorities both in terms of prevalence and disease-related complications. To understand this disparity, the present study seeks to: 1) examine the impact of post-traumatic stress symptoms (PTSS) at baseline on changes in glucose metabolism, fasting glucose (FG) and glycated hemoglobin (HgbA1c), and determine whether this predictive association differs by race, sex, and/or their interaction; and 2) determine the extent to which the association between baseline PTSS and glucose metabolism changes is explained separately by depressive symptoms, cigarette use, inflammation and adiposity, and determine whether these mechanisms differ by race, sex, and/or their interaction. Methods: Participants (N =2,172) were Black/African American (55%) and White, men (44%) and women from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study who at baseline did not have diabetes, i.e., HgbA1c less than 6.5%, no self-reported medical history of diabetes or current use of diabetes medication. Participants were measured up to three times over a 13-year period on PTSS (baseline only), depressive symptoms, cigarette use, C-Reactive Protein (CRP), white blood cell count (WBC), erythrocyte sedimentation rate (ESR), body mass index (BMI), FG, and HgbA1c. Results: Linear mixed effects regressions revealed 5-way interactions (PTSS*Race*Sex*Age*Age) and revealed similar patterns of findings across glucose metabolism indicators. Most notably, among Black women and White men only, higher PTSS levels were associated with greater linear increases in glucose metabolism. Moreover, of the four biopsychosocial mechanisms tested, only the inflammatory composite had consistent evidence across glucose metabolism outcomes. Among women only, higher PTSS levels were associated with greater increases in inflammation which in turn were associated with less changes in glucose metabolism, or greater stability in elevated levels since higher levels of inflammation were associated with higher glucose metabolism levels. Discussion: PTSS may accelerate trajectories of glucose metabolism and, consequently, increase the risk for earlier diabetes incidence. Identifying and treating individuals, particularly Black women, with high levels of PTSS may be an important clinical priority for diabetes prevention as this may prevent or delay T2DM and its sequelae.Keywords: diabetes risk, posttraumatic stress, longitudinal cohort study, biopsychosocial mechanisms