Hyperglycemia and Diabetes in Patients With Schizophrenia or Schizoaffective Disorders

Abstract

OBJECTIVE—Pharmacoepidemiological studies have shown an increased prevalence of diabetes in patients with schizophrenia. To address this issue, we decided to assess glucose metabolism in a population of patients with schizophrenia or schizoaffective disorder. RESEARCH DESIGN AND METHODS—Oral glucose tolerance tests (OGTTs) were performed in 200 unselected in- and outpatients. Insulin sensitivity and β-cell function were assessed using the homeostasis model assessment (HOMA) indexes and 30-min glucose and insulin levels. RESULTS—The mainly Western European (87.7%) study population had a mean age of 40.8 years, was 70% male, and had a mean fasting glucose of 5.1 mmol/l and a mean fasting insulin of 14.8 mU/l. Hyperglycemia was present in 7% of the population: 1.5% with impaired fasting glucose and 5.5% with impaired glucose tolerance. The prevalence of diabetes was 14.5%, of which 8% was previously known and 6.5% was newly diagnosed. Compared with a 1.5% prevalence of diabetes in the age-matched general Dutch population, the prevalence of identified cases was significantly increased in the study population. Comparable figures on the prevalence of hyperglycemia in the general population are not available. Insulin resistance was increased in the study population as a whole (HOMA of insulin resistance: 3.1–3.5), irrespective of the use of antipsychotic medication and, if used, irrespective of its type (typical or atypical). No indication of β-cell defect was found, whereas a nonsignificant increased insulin resistance was found with antipsychotic medication. CONCLUSIONS—OGTTs in 200 mainly Caucasian patients with schizophrenia or schizoaffective disorder, mean age 41 years, showed that 7% suffered from hyperglycemia and 14.5% from diabetes. The prevalence of diabetes was significantly increased compared with the general population. No differential effect of antipsychotic monotherapy in diabetogenic effects was found. Therefore, a modification of the consensus statement on antipsychotic drugs, obesity, and diabetes is proposed, i.e., measurement of fasting glucose in all patients with schizophrenia, irrespective of prescribed antipsychotic drug.

Antipsychotics Associated with the Development of Type 2 Diabetes in Antipsychotic-Naïve Schizophrenia Patients

“…In our study, the mean age of diabetes onset was around 41 years. This is lower than in the general population and similar to the results from earlier studies with antipsychotics (Cohen et al, 2006). In the first half of the last century, female sex was considered as risk factor for type 2 diabetes, but this difference had vanished by the end of the last century (Gale and Gillespie, 2001).…”

Effects of Olanzapine and Ziprasidone on Glucose Tolerance in Healthy Volunteers

“…Some authors claim that evidence for insulin resistance, hyperglycemia, and DM2 in patients with major mental disorders are due to an increased prevalence for certain abnormalities in glucose metabolism initially associated with the mental disorder itself and are not necessarily related to any antipsychotic treatment (Mukherjee et al, 1996;Ryan et al, 2003;Cohen et al, 2006). A mechanistic study in dogs proposes a valuable model to examine the effects of atypical antipsychotics in the absence of associated psychiatric disorders .…”

Hyperglycemia and Diabetes in Patients With Schizophrenia or Schizoaffective Disorders

“…e thank Kanna and AbreuPacheco (1) for their comments on our study (2). As Kanna and Abreu-Pacheco point out, overweight and obesity are strongly linked to the development of type 2 diabetes and can complicate its management.…”

“…As Kanna and Abreu-Pacheco point out, overweight and obesity are strongly linked to the development of type 2 diabetes and can complicate its management. While most patients with type 2 diabetes are overweight (3), this study (2) included individuals with a range of BMI values typical of those seen in clinical practice; mean BMI in the inhaled insulin and glibenclamide groups was 31.8 (range 19 -51) and 31.1 (22-47), respectively. When analyzed by baseline BMI values, the mean change from baseline A1C in the moderately high A1C arm (Ն8 to Յ9.5%) was Ϫ1.6, Ϫ1.3, and Ϫ1.5% in patients with baseline BMI values of Ͻ30, 30 -35, and Ն35 kg/m 2 , respectively, compared with Ϫ1.5% for all subjects.…”