Risk of Diabetes in U.S. Military Service Members in Relation to Combat Deployment and Mental Health
- Edward J. Boyko, MD1,
- Isabel G. Jacobson, MPH2,
- Besa Smith, PHD3,
- Margaret A.K. Ryan, MD3,
- Tomoko I. Hooper, MD4,
- Paul J. Amoroso, MD5,
- Gary D. Gackstetter, PHD6,
- Elizabeth Barrett-Connor, MD7,
- Tyler C. Smith, PHD2 and
- for the Millennium Cohort Study Team*
- 1Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington;
- 2Department of Deployment Health Research, Naval Health Research Center, San Diego, California;
- 3Naval Hospital Camp Pendleton, Camp Pendleton, California;
- 4Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland;
- 5Madigan Army Medical Center, Tacoma, Washington;
- 6Analytic Services, Inc. (ANSER), Arlington, Virginia;
- 7Division of Epidemiology/Family and Preventive Medicine, University of California, San Diego, San Diego, California.
- Corresponding author: Edward J. Boyko, .
OBJECTIVE Few prospective data exist on the risk of diabetes in individuals serving in the U.S. military. The objectives of this study were to determine whether military deployment, combat exposures, and mental health conditions were related to the risk of newly reported diabetes over 3 years.
RESEARCH DESIGN AND METHODS Data were from Millennium Cohort Study participants who completed baseline (July 2001–June 2003) and follow-up (June 2004–February 2006) questionnaires (follow-up response rate = 71.4%). After exclusion criteria were applied, adjusted analyses included 44,754 participants (median age 36 years, range 18–68 years). Survey instruments collected demographics, height, weight, lifestyle, military service, clinician-diagnosed diabetes, and other physical and mental health conditions. Deployment was defined by U.S. Department of Defense databases, and combat exposure was assessed by self-report at follow-up. Odds of newly reported diabetes were estimated using logistic regression analysis.
RESULTS Occurrence of diabetes during follow-up was 3 per 1,000 person-years. Individuals reporting diabetes at follow-up were significantly older, had greater baseline BMI, and were less likely to be Caucasian. After adjustment for age, sex, BMI, education, race/ethnicity, military service characteristics, and mental health conditions, only baseline posttraumatic stress disorder (PTSD) was significantly associated with risk of diabetes (odds ratio 2.07 [95% CI 1.31–3.29]). Deployments since September 2001 were not significantly related to higher diabetes risk, with or without combat exposure.
CONCLUSIONS In this military cohort, PTSD symptoms at baseline but not other mental health symptoms or military deployment experience were significantly associated with future risk of self-reported diabetes.
This represents report 09-35, supported by the U.S. Department of Defense, under work unit no. 60002. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of Veterans Affairs, Department of the Navy, Department of the Army, Department of the Air Force, Department of Defense, or the U.S. Government. This research has been conducted in compliance with all applicable federal regulations governing the protection of human subjects in research (protocol NHRC.2000.0007). The funding organization had no role in the design and conduct of the study; collection, analysis, or preparation of data; or preparation, review, or approval of the manuscript.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
- © 2010 by the American Diabetes Association.
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