Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta‐analysis

Abstract

Type 2 diabetes mellitus (T2DM) is highly predictive of cardiovascular diseases and can have particularly deleterious health impacts in people with severe mental illness (SMI), i.e. schizophrenia, bipolar disorder or major depressive disorder. This meta-analysis aimed: a) to describe pooled frequencies of T2DM in people with SMI; b) to analyze the influence of demographic, illness and treatment variables as well as T2DM assessment methods; and c) to describe T2DM prevalence in studies directly comparing persons with each specific SMI diagnosis to general population samples. The trim and fill adjusted pooled T2DM prevalence among 438,245 people with SMI was 11.3% (95% CI: 10.0%-12.6%). In antipsychotic-na€ ıve participants, the prevalence of T2DM was 2.9% (95% CI: 1.7%-4.8%). There were no significant diagnostic subgroup differences. A comparative meta-analysis established that multi-episode persons with SMI (N5133,470) were significantly more likely to have T2DM than matched controls (N55,622,664): relative risk, RR51.85, 95% CI: 1.45-2.37, p<0.001. The T2DM prevalence was consistently elevated in each of the three major diagnostic subgroups compared to matched controls. Higher T2DM prevalences were observed in women with SMI compared to men (RR51.43, 95% CI: 1.20-1.69, p<0.001). Multi-episode (versus first-episode) status was the only significant predictor for T2DM in a multivariable meta-regression analysis (r 2 50.52, p<0.001). The T2DM prevalence was higher in patients prescribed antipsychotics, except for aripriprazole and amisulpride. Routine screening and multidisciplinary management of T2DM is needed. T2DM risks of individual antipsychotic medications should be considered when making treatment choices. . Type 2 diabetes mellitus (T2DM) is a major risk factor for CVD. It confers about a two-fold excess risk for coronary heart disease, major stroke subtypes, and deaths attributed to other vascular causes 13,14 . Prevention and treatment of T2DM demand careful consideration in clinical practice, particularly in populations with an increased risk for CVD and associated premature mortality 15,16 . Recent meta-analyses [17][18][19][20] demonstrated that all diagnostic SMI subgroups have a higher risk for developing T2DM than the general population. However, meta-analytic data comparing T2DM risks across different psychiatric diagnoses are currently lacking. Furthermore, there are no meta-analytic data that combine all major diagnostic SMI subgroups, and information on the prevalence of T2DM among people with SMI prescribed different antipsychotic medication classes is insufficient. Large-scale pooled analyses in the SMI population are relevant, as they enable investigation of risk factors across large numbers of studies and participants, distinguishing risk factors for T2DM associated with specific SMIs from those independent of these illnesses. Pooling data across major diagnostic categories allows for investigation of the effect of demographic variables (gender, age, illness duration, study setting, geograp...

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