Altered metabolic parameters in association with antipsychotic medication use in diabetes: A population based case-control study

Abstract

Altered metabolic parameters in association with antipsychotic medication use in diabetes Wake, D. J.; Broughton, P.; Perera, S. M.; MacIntyre, D. J.; Leese, G. P. Published in: Psychoneuroendocrinology DOI:10.1016/j.psyneuen.2016.01.022 Publication date: 2016 Document Version Peer reviewed version Link to publication in Discovery Research PortalCitation for published version (APA): Wake, D. J., Broughton, P., Perera, S. M., MacIntyre, D. J., & Leese, G. P. (2016). Altered metabolic parameters in association with antipsychotic medication use in diabetes: A population based case-control study. Psychoneuroendocrinology, 66, 214-220. https://doi.org/10.1016/j.psyneuen.2016.01.022 General rightsCopyright and moral rights for the publications made accessible in Discovery Research Portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from Discovery Research Portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain.• You may freely distribute the URL identifying the publication in the public portal. Take down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Tables and Figures: 2 Tables and 2 Figures ABSTRACT AimsThis study assess differences in clinical variables in diabetes patients prescribed antipsychotic medication and determines relative schizophrenia prevalence in the diabetes population. MethodsThis population-based case-control study utilising Scotland's national diabetes registry (SCIdiabetes) and linked psychiatric hospital discharge data (SMR04) established diabetes phenotypes in a patient cohort prescribed long term antipsychotic medication (n=2362)(cases). Cases were matched 1:10 to diabetes patients not prescribed antipsychotic medication (controls) for BMI, gender; diabetes type; birth year; diagnosis date; smoking status. Sub-groups with defined schizophrenia (n=196) or bipolar disorder (n= 190) were further examined. Schizophrenia prevalence in the diabetes versus general population was compared. ResultsDuring follow up, antipsychotic prescription was associated with lower HbA1c (55.1 (95% CI 54.5-55.8) or 7.2 (95% CI 7.1-7.3)% vs 58.2 (58.0-58.4) mmol or 7.5 (95% CI 7.5-7.5)% p<0.001) lower serum total cholesterol, 4.2 (4.1-4.2) vs 4.3 (4.2-4.3) mmol/ l, p<0.001), lower blood pressure (systolic 130 (130.17-131.29) vs 134 (134.3-134.7) mmHg, p<0.001), higher prescription of oral hypoglycaemic medication (42% (40-45) vs 38% (37-39) p<0.001), similar statin prescriptions (85% (81-89) vs 85% (84-86), p=.55), and lower retinopathy rates (28% (25.6-30.5) vs 32% (31.5-33.1), p<0.001). HbA1c at diagnosis was similar (p=.27).Schizophrenia prevalence was higher in the diabetes versus gene...

Glucose, cholesterol and blood pressure in type II diabetes: A longitudinal observational study comparing patients with and without severe mental illness

“…Our study is the first to comparatively evaluate markers of cardiovascular risk factors in people with SMI using longitudinal data. Two previous studies, one a case–control study (matching patients with schizophrenia with controls on factors including BMI) and one a cross‐sectional study, observed significantly lower HbA 1c levels in SMI groups compared with non‐SMI groups (Dixon et al, ; Wake et al, ). We observed no significant initial difference in mean HbA 1c between groups, but we included patients without schizophrenia and did not follow the same matching approach.…”

“…Controlling HbA 1c and optimising lipid and blood pressure management reduce the risks of microvascular and macrovascular complications, which remain the main cause of morbidity and mortality in patients with T2DM (Collaborators, 2008;Khaw, Wareham, & Luben, 2001;Ray et al, 2009;UK Prospective Diabetes Study Group, 1998). However, the evidence for appropriate management of cardiovascular risk factors in patients with diabetes and SMI is inconclusive, particularly in the UK (Dixon et al, 2004;Wake, Broughton, Perera, MacIntyre, & Leese, 2016). A small study in the United States showed that patients with SMI had lower levels of HbA 1c compared to patients without SMI (Dixon et al, 2004), and a recent larger study suggested that people with T2DM taking antipsychotic medication have lower cholesterol, HbA 1c and blood pressure levels compared with matched controls not taking antipsychotic medication (Wake et al, 2016).…”

“…However, the evidence for appropriate management of cardiovascular risk factors in patients with diabetes and SMI is inconclusive, particularly in the UK (Dixon et al, ; Wake, Broughton, Perera, MacIntyre, & Leese, ). A small study in the United States showed that patients with SMI had lower levels of HbA 1c compared to patients without SMI (Dixon et al, ), and a recent larger study suggested that people with T2DM taking antipsychotic medication have lower cholesterol, HbA 1c and blood pressure levels compared with matched controls not taking antipsychotic medication (Wake et al, ). There is, however, little evidence at a population level on the changes in cardiovascular risk factors over time in those with SMI that develop T2DM compared to those with T2DM and no SMI.…”

Antidepressant and antipsychotic drug prescribing and complications of diabetes: a systematic review of observational studies

“…Just four studies reported on antipsychotic prescribing in relation to diabetes outcomes. The two studies that investigated the association between antipsychotic prescribing and clinical complications of diabetes used population-based national registers [24, 32]. A cohort study of people with schizophrenia found that, compared to no antipsychotic prescribing, regular antipsychotic prescribing was associated with a 20% and 27% reduced risk of cardiovascular morbidity, and all-cause mortality, respectively [24] (Table 3).…”

“…Details of the antidepressant and antipsychotic drugs included with each study are given in Supplemental Table 2. Eleven studies were cohort [16][17][18][19][20][21][22][23][24][25][26], one was a self-controlled before and after study [27], two were case-control [28,29], and four were cross-sectional studies [30][31][32][33]. Two studies included overlapping study populations [21,27], but adopted different study designs to address a similar question and so both were included in the narrative synthesis.…”