Longitudinal Associations of Posttraumatic Stress Disorder with Incident Type 2 Diabetes and Poor Glycemic Control in a Large National Cohort - Project Summary This K08 Mentored Clinical Scientist Development Award will provide Dr. Kelsey Serier with training to develop an independent research career devoted to understanding the effect of trauma and trauma-related negative mental health sequalae, namely posttraumatic stress disorder (PTSD), on the development and course of type 2 diabetes (T2D). Dr. Serier has assembled an impressive interdisciplinary mentorship team comprised of experts in trauma, behavioral science, epidemiology, endocrinology, and health informatics to support her development and successful completion of the proposed training and research goals. Through a comprehensive and carefully designed training plan, Dr. Serier will address previous training gaps and develop skills in (1) domain-specific knowledge related to PTSD and T2D, (2) epidemiologic methods and longitudinal data analysis, and (3) professional development and grant writing. A cross-cutting training goal is furthering her skills in conducting interdisciplinary team science. The proposed research program leverages the largest electronic health record cohort of individuals at risk of T2D (n = 6,082,018) in the United States. Data come from the Veteran’s Health Administration and includes an extensive set of clinician-based diagnoses, laboratory tests, and up to 15 years of follow-up data. Utilizing this cohort, the current study aims to address several critical gaps in our current knowledge of PTSD and T2D, specifically: (1) a lack of prospective data that include clinician-derived diagnostic information, (2) minimal consideration of psychiatric comorbidity, (3) limited investigation of PTSD on outcomes in individuals with T2D, including glycemic control, and (4) an absence of studies considering the impact of sex, race, and ethnicity. Aim One will estimate the effect of PTSD, depression, and their comorbidity on the rate of T2D using cox proportional hazard models and interaction contrasts. Aim Two will include individuals who developed T2D during the study period (n = 936,596). A series of conditional logistic regression models and interaction contrasts will be used to estimate the odds of poor glycemic control in PTSD, depression, and their comorbidity relative to non-psychiatric comparison groups. Aim Three will examine the extent to which sex, race, and ethnicity modify the associations in Aims One and Two. The current study includes a large number of women (n = 504,002) and individuals identifying as non- Hispanic Black (n = 888,465), and Hispanic and Latino (n = 331, 817) to allow for analyses examining the differential effect of PTSD on T2D in subpopulations with a higher burden of disease. The unique data source and methodological rigor of the proposed study offers an efficient way to examine the associations between PTSD and a range of T2D-related outcomes, which will ultimately inform targeted T2D prevention and intervention approaches. Furthermore, the project will provide the applicant with essential interdisciplinary training for an independent and integrative research program examining associations between the psychological sequalae of trauma and T2D.
