Prevalence of diabetes and the metabolic syndrome in a sample of patients with bipolar disorder

Abstract

Objectives: The presence of metabolic abnormalities is an important risk factor for cardiovascular disease and diabetes. There are limited data on the prevalence of the metabolic abnormalities in disorders other than schizophrenia in which antipsychotic medication is part of routine treatment.Methods: Sixty consecutive patients with bipolar disorder (BD) at our university psychiatric hospital and affiliate services were entered in an extensive prospective metabolic study including an oral glucose tolerance test. The prevalence of the metabolic syndrome was assessed based on the National Cholesterol Education Program Adult Treatment Protocol (ATP-III) criteria, the adapted ATP-III criteria using a fasting glucose threshold of 100 mg/dL, and the recently proposed criteria from the International Diabetes Federation (IDF).Results: The analysis of 60 patients showed a prevalence of the metabolic syndrome of 16.7% (ATP-III), 18.3% (adapted ATP-III) and 30.0%) (IDF), respectively. A total of 6.7% of the patients met criteria for diabetes and 23.3% for pre-diabetic abnormalities. Conclusions:The metabolic syndrome and glucose abnormalities are highly prevalent among patients with BD. They represent an important risk for cardiovascular and metabolic disorders. Assessment of the presence and monitoring of metabolic abnormalities and its associated risks should be part of the clinical management of patients with BD. Key words: bipolar disorder -diabetes -metabolic syndrome -physical healthSince the introduction of second-generation antipsychotics and their association with metabolic abnormalities, there has been a rise of interest in the occurrence of metabolic abnormalities in patients treated with these drugs, although the main focus of research was on patients diagnosed with schizophrenia (1-3). The issue of abnormalities in glucose metabolism has received most attention (1, 4-9).Next to diabetes, there has been a surge of interest into other medical conditions such as cardiovascular morbidity, abnormal lipid metabolism and obesity that also have a serious impact on the physical health. In patients with schizophrenia, recent research has demonstrated a prevalence of 40-50% of the metabolic syndrome, which comprises abnormalities in glucose metabolism, lipid metabolism, obesity and blood pressure (10-12).In contrast to patients diagnosed with schizophrenia, research on metabolic abnormalities in patients with bipolar disorder (BD) has been relatively scarce. Three retrospective chart reviews of patients with BD (13-15), one of which also investigated diabetes prevalence in patients with schizoaffective disorder and schizophrenia (15), * MDeH has been a consultant to, received grant /research support and honoraria from, and has served on the speakers/advisory boards of AstraZeneca, Lundbeck JA, Janssen-Cilag, Eli Lilly & Co., Pfizer, Sanofi and Bristol-Myers Squibb. DVE has served on the speakers/advisory board of Sanofi. LH is an employee of Bristol-Myers Squibb. AS has served on the speakers/advisory boards of P...

Assessment of Insulin Resistance and Metabolic Syndrome in Drug Naive Patients of Bipolar Disorder

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Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review

“…27,28 Since that time, other reports suggest even higher rates, with the prevalence of diabetes in people with SMI typically being twofold to threefold higher than age-matched samples from the general population. 10,[29][30][31][32][33][34][35] We are aware of only two large studies examining pre-diabetes among people with schizophrenia. 36,37 One study of older veterans with schizophrenia (mean age 59.6 yrs) screened for diabetes (N = 12,587, >95 % men) found that 42 % of these patients had pre-diabetes, which is comparable to 50 % of U.S. elderly adults.…”

Comorbidity Profile and Healthcare Utilization in Elderly Patients with Serious Mental Illnesses

“…This discrepancy is at least in part generally explained as being caused by increases in comorbid medical conditions in the mentally ill, particularly chronic illnesses such as diabetes (6–9) and cardiovascular disease (2, 10–14). To alleviate these problems there have been reports of clinical interventions to improve health care in the seriously mentally ill with some success (15, 16).…”