Meta-analysis of glucose tolerance, insulin, and insulin resistance in antipsychotic-naïve patients with nonaffective psychosis

Abstract

Background Some studies have suggested antipsychotic-naive patients with nonaffective psychosis (NAP) have glucose intolerance. Aims To conduct a systematic review and meta-analysis of fasting glucose (FG), two hour values in the oral glucose tolerance test (2HG), fasting insulin concentration (INS), and insulin resistance (IR). Method We identified possibly relevant studies, then selected studies, following usual guidelines, with two authors reviewing the manuscripts. We required studies to include subjects with nonaffective psychosis and control subjects. Results There were 911 patients and 870 control subjects in the analysis of FG; their average ages were respectively 28.7 and 29.5 years. Significant differences were found for all four variables, with effect size estimates ranging from 0.21 to 0.58. Conclusions As a group, at the time of first clinical contact for psychosis, people with NAP have a slight increase in FG, which most of them maintain in the normal range despite a small increase in IR by secreting additional INS. When faced with a physiological challenge such as a glucose tolerance test or antipsychotics, they are no longer able to maintain a normal glucose concentration.

Antipsychotic treatment is associated with inflammatory and metabolic biomarkers alterations among first‐episode psychosis patients: A 7‐month follow‐up study

“…These observations are in line with cross‐sectional results demonstrating that the prevalence of diabetes is greater in patients of SCZ compared to the general population (Kohen, ). A recent meta‐analysis has confirmed these findings, and has revealed impaired glucose tolerance (IGT) in antipsychotic‐naïve first‐episode psychosis (FEP) patients, as compared to control subjects (CS) (Greenhalgh et al, ). IGT has also been demonstrated in non‐psychotic, first‐degree relatives of patients of SCZ, further indicating a heritable phenotype that tracks with the risk of psychosis, but is independent of the actual development of a psychotic disorder (Spelman, Walsh, Sharifi, Collins, & Thakore, ).…”

Glucose metabolism dysregulation at the onset of mental illness is not limited to first episode psychosis: A systematic review and meta‐analysis

“…While research regarding glucose metabolism in treatment‐naïve, first episode patients with individual SMI suggest a pre‐diabetic condition, we have limited knowledge on the differences of glucose metabolism across different diagnostic categories of SMIs. Therefore, the first aim of this study is to extend previous findings in patients with FEP (Greenhalgh et al, ; Perry et al, ; Pillinger et al, ) by conducting a systematic review and a meta‐analysis of glucose intolerance in first episode, treatment‐naïve patients with FEP, as well as first episode, treatment‐naïve patients with depression and bipolar disorder. The second aim of this study is to compare the differences of pooled results from glucose metabolism outcomes between these diagnostic categories.…”

“…Several factors, including adverse effects of antipsychotic medications, altered inflammatory processes and possibly shared genetic links between schizophrenia and DM2 likely contribute to comorbidity between these two disorders (Calkin, Gardner, Ransom, & Alda, ; Ferentinos & Dikeos, ; Garcia‐Rizo, Kirkpatrick, Fernandez‐Egea, Oliveira, & Bernardo, ; Perry, McIntosh, Weich, Singh, & Rees, ; Yamagata et al, ). Research dating back to the pre‐anti‐psychotic era (Henneman, Altschule, & Goncz, ) as well as findings from treatment‐naïve, first episode psychosis (FEP) patients suggest a pre‐diabetic condition with impaired glucose metabolism at the onset of the psychotic illness (Arranz et al, ; Greenhalgh et al, ; Misiak et al, ; Perry et al, ; Ryan, Collins, & Thakore, ; Spelman, Walsh, Sharifi, Collins, & Thakore, ). A recent Danish register study published in by Rajkumar et al reported 3.07 adjusted hazard ratio of diabetes diagnosis in treatment‐naïve FEP patients compared to population sample, suggesting an increased endogenic risk for DM2 in FEP patients (Cohen & De Hert, ; Rajkumar et al, ).…”

“…A recent Danish register study published in by Rajkumar et al reported 3.07 adjusted hazard ratio of diabetes diagnosis in treatment‐naïve FEP patients compared to population sample, suggesting an increased endogenic risk for DM2 in FEP patients (Cohen & De Hert, ; Rajkumar et al, ). Three recent meta‐analyses have shown significantly higher insulin resistance (IR), HbA1c, fasting insulin and glucose levels after oral glucose tolerance test (OGTT) in treatment‐naïve, FEP compared to healthy controls (Greenhalgh et al, ; Perry et al, ; Pillinger et al, ). One of these meta‐analyses (Greenhalgh et al, ) also showed higher fasting glucose levels in patients with FEP compared to healthy controls, whereas others reported no difference on fasting glucose levels between these two groups.…”

“…Three recent meta‐analyses have shown significantly higher insulin resistance (IR), HbA1c, fasting insulin and glucose levels after oral glucose tolerance test (OGTT) in treatment‐naïve, FEP compared to healthy controls (Greenhalgh et al, ; Perry et al, ; Pillinger et al, ). One of these meta‐analyses (Greenhalgh et al, ) also showed higher fasting glucose levels in patients with FEP compared to healthy controls, whereas others reported no difference on fasting glucose levels between these two groups.…”