Schizophrenia and type 2 diabetes mellitus

Abstract

S chizophrenia is associated with increased risk for type 2 diabetes mellitus, resulting in elevated cardiovascular risk and limited life expectancy, translated into a weighted average of 14.5 years of potential life lost and an overall weighted average life expectancy of 64.7 years. The exact prevalence of type 2 diabetes among people with schizophrenia varies across studies and ranges 2-5fold higher than in the general population, whereas the aetiology is complex and multifactorial. Besides common diabetogenic factors, applied similarly in the general population, such as obesity, hyperlipidemia, smoking, hypertension, poor diet and limited physical activity, the co-occurrence of schizophrenia and diabetes is also attributed to unique conditions. Specifically, excessive sedentary lifestyle, social determinants, adverse effects of antipsychotic drugs and limited access to medical care are considered aggravating factors for diabetes onset and low quality of diabetes management. Schizophrenia itself is further proposed as causal factor for diabetes, given the observed higher prevalence of diabetes in young patients, newly diagnosed with schizophrenia and unexposed to antipsychotics. Furthermore, studies support genetic predisposition to diabetes among people with schizophrenia, suggesting shared genetic risk and disclosing a number of overlapped risk loci. Therefore, special attention should be paid in preventing diabetes in people with schizophrenia, through intervention in all possible modifiable risk factors. Implementation of careful antipsychotic prescription, provision of adequate motivation for balanced diet and physical activity and facilitating access to primary health care, could serve in reducing diabetes prevalence. On the other hand, increasing calls are made for early diagnosis of diabetes, application of the appropriate anti-diabetic therapy and strict inspection of therapy adherence, to limit the excess mortality due to cardiovascular events in people with schizophrenia. Moreover, population health programs could help counseling and preventing diabetes risk, additionally to early screening and diagnosis set, aiming to reduce disparities in populations. Finally, mental health-care providers might greatly promote offered health services to patients with schizophrenia, through a holistic individualized approach, considering additionally the physical health of the patients and working closely, preventively and therapeutically, in collaboration with the physicians and diabetologists.

The adaptation and implementation of the Health Improvement Profile to Australian standards in public mental health settings

“…For example, in Victoria six per cent of all adults have been diagnosed with type 2 diabetes; however, in the population of service users with mental illness in the years 2015-2016, 10.6% of these service users had a diagnosis of type 2 diabetes (Victorian Government, 2017). This finding has also been replicated in other studies, finding type 2 diabetes twice as prevalent in service users with a diagnosis of serious mental illness when compared to the general population (Annamalai, Kosir, & Tek, 2017;Mamakou, Thanopoulou, Gonidakis, Tentolouris, & Kontaxakis, 2018). This internationally important issue was highlighted in another study that found service users with depression suffered nearly three times more chronic medical conditions than those without depression (Druss, Rask, & Katon, 2008).…”

Association between mental health comorbidity and health outcomes in type 2 diabetes mellitus patients

“…It is well known that antipsychotics are associated with an increased risk of obesity, metabolic syndrome and diabetes mellitus 53 . Excess mortality and all-cause hospitalizations could be explained by aggravating factors for T2D onset and poor diabetes management present in individuals with schizophrenia, such as excessive sedentary lifestyle, social determinants, adverse effects of antipsychotic drugs or limited access to medical care 53,54 .…”

“…We calculated the prevalence of each type of mental health comorbidity in the study population by sex and age group (i.e., [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64], 65-74, 75-84 and ≥ 85 years). We analysed demographic and clinical information of the study population according to the presence or not of mental health comorbidity by means or frequencies/proportions.…”

Gray Matter Abnormalities in Type 1 and Type 2 Diabetes: A Dual Disorder ALE Quantification

“…Schizophrenia has long been found to link with increased risk of T2DM, as the prevalence of type 2 diabetes is 2–5-fold higher in patients with schizophrenia when compared with those without DM (Mamakou et al, 2018 ). While this may due to the impact of antipsychotic treatment and also the disease progression, the fact that drug native patients of schizophrenia were still at 1.27–1.63-fold of risk of having T2DM than general population (Cohen and De Hert, 2011 ) may suggested that there is uniquely shared risk factor between the two diseases.…”