Birth weight, family history of diabetes and diabetes onset in schizophrenia

Abstract

IntroductionThe prevalence of diabetes in schizophrenia is twice that in the general population, but there are few reliable predictors of which individuals will develop glucose dysregulation.ObjectiveTo test if abnormal birth weight (either too low or too high) and parental diabetes, both variables that can be ascertained in the clinic, can predict diabetes onset in patients with schizophrenia.Research design and methodsElectronic records of a cohort of 190 clozapine-treated patients (37% treated for more than 20 years) and Cox regression survival analysis (with any type of glucose dysregulation as the event) to account for differences in length of treatment before the event and age at clozapine treatment initiation.ResultsAge at clozapine initiation (Exp(B)=1.098; p<0.001), family history of diabetes (Exp(B)=2.299; p=0.049) and birth weight2 (Exp(B)=0.999; p=0.013) were significant predictors of glucose dysregulation onset, while gender was not (Exp(B)=0.1.350; p=0.517). Among individuals with 10 years of follow-up, 80% of those with both abnormal birth weight and a family history of diabetes developed diabetes compared with 56% with only abnormal birth weight, 40% with only a family history of diabetes and 20% in those with neither.ConclusionsSince 48% of cases had at least one risk factor and 6% had both risk factors, there is a substantial proportion of patients for whom preventive strategies could be implemented.

Oxidative-Antioxidant Imbalance and Impaired Glucose Metabolism in Schizophrenia

“…GLUT1 and GLUT3 are immediately attached to cell membranes. In contrast to these transporters, GLUT4 located in intracellular vesicles on the periphery through hypoglycemia trigger the hunger mechanism coupled with food acquisition by stimulating insulin release, so that energy and body mass remain in balance [50]. Transporters such as GLUT1 and GLUT3 occurring mainly in the frontal lobes are therefore decisive in the brain glucose metabolism in humans.…”

Anthropometry in antipsychotic-naïve first-episode psychosis patients: An exploratory approach to the role of environmental early life events in two independent samples

“…Our results are in line with other studies where BW was associated with outcomes related with anthropometry. BW has been associated with antipsychotic-induced obesity (Ziauddeen et al, 2016) and with T2DM in schizophrenia (Fernandez-Egea et al, 2020) and in severe mental illness (Garriga et al, 2019b;Wium-Andersen et al, 2022). Previous articles suggest that some risk is present at onset (associated with different BW) and is related with the later development of metabolic abnormalities.…”

The effect of early life events on glucose levels in first-episode psychosis

“…Several studies have described factors affecting antipsychotic-induced weight gain in FEP patients, which can be theoretically translated as factors of glucose abnormalities ( 4 , 36 ). However, only a few studies have focused on the effect of early life events, either perinatal ( 20 , 22 – 25 ) or postnatal ( 37 , 38 ).…”

“…In a transversal study assessing treatment-resistant patients diagnosed with schizophrenia, BW was associated with abdominal obesity ( 24 ). In a retrospective study, BW was associated with the onset of T2DM in a cohort of treatment-resistant schizophrenia patients ( 25 ). This could be referred to as the “metabolic imprinting” of early life events in psychosis, suggesting that both mental diagnosis and metabolic disturbances might behave as epiphenomena of early life events ( 12 ).…”