Screening for Diabetes and Other Metabolic Abnormalities in Patients with Schizophrenia and Schizoaffective Disorder: Evaluation of Incidence and Screening Methods

Winkel, Ruud van; Hert, Marc De; Eyck, Dominique Van; Hanssens, Linda; Wampers, Martien; Scheen, André

doi:10.2165/00002018-200629100-00160

Cited by 33 publications

(52 citation statements)

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“…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.…”

Section: Smi and Type 2 Diabetesmentioning

confidence: 99%

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

et al. 2016

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Close to 19 million US adults have severe mental illnesses (SMI), and they die, on average, 25 years earlier than the general population, most often from cardiovascular disease (CVD). Many of the antipsychotic medications used to treat SMI contribute to CVD risk by increasing risk for obesity, type 2 diabetes, dyslipidemia, and hypertension. Based on compelling evidence, the American Diabetes Association and the American Psychiatric Association developed guidelines for metabolic screening and monitoring during use of these medications. In this manuscript, we have reviewed the evidence on diabetes and other CVD risk screening, prevalence, and management among populations with SMI. We also review differences in screening among subpopulations with SMI (e.g., racial/ethnic minorities, women, and children). We found that despite national guidelines for screening for diabetes and other cardiovascular risk factors, up to 70 % of people taking antipsychotics remain unscreened and untreated. Based on estimates that 20 % of the 19 million US adults with SMI have diabetes and 70 % of them are not screened; it is likely that over 2 million Americans with SMI have unidentified diabetes. Given that undiagnosed diabetes costs over $4,000 per person, this failure to identify diabetes among people with SMI represents a missed opportunity to prevent morbidity and translates to over $8 billion in annual preventable costs to our healthcare system. Given the high burden of disease and significant evidence of suboptimal medical care received by people with SMI, we propose several clinical and policy recommendations to improve diabetes and other CVD risk screening and care for this highly vulnerable population. These recommendations include reducing antipsychotic medication dose or switching antipsychotic medications, enhancing smoking cessation efforts, sharing electronic health records between physical and mental health care systems, and promoting integration of care.KEY WORDS: mental illness; diabetes; integration of care.

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Section: Smi and Type 2 Diabetesmentioning

confidence: 99%

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

et al. 2016

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“…All participants received a comprehensive metabolic screening including a 2-hour 75-g glucose load oral glucose tolerance test (OGTT) van Winkel et al, 2006). Patients were initiated on an overnight fast and were monitored during the OGTT.…”

Section: Metabolic Syndromementioning

confidence: 99%

Metabolic syndrome and lung function in schizophrenia: A pilot study

Vancampfort

Probst

Stubbs

et al. 2014

Psychiatry Research

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“…Especially the important question whether the antipsychotic-associated increased risk of diabetes is a class effect remains largely unresolved because of numerous confounding factors and conflicting results [7,8]. In addition to diabetes per se, milder glucose dysregulation has been described in numerous patients receiving atypical antipsychotics, such as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) assessed during an oral glucose tolerance test (OGTT) [9][10][11]. A higher risk of developing a metabolic syndrome, which includes IFG in its various definitions, has also been stressed in recent studies [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…Risk for CVD and overall mortality due to CVD is elevated in patients suffering from schizophrenia compared to the general population, with mortality rates in this population being at least two times higher than in general population and CVD being responsible for as much as 50% of the excess mortality [16,17]. Recently, there has been an increased awareness of the physical needs of patients with mental illness and several psychiatric clinics, including ours, have set up physical health screening [11,18]. Such screening has unmasked a substantial degree of pathology, especially metabolic disturbances considered as CVD risk factors, including diabetes mellitus [10,11,15].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, there has been an increased awareness of the physical needs of patients with mental illness and several psychiatric clinics, including ours, have set up physical health screening [11,18]. Such screening has unmasked a substantial degree of pathology, especially metabolic disturbances considered as CVD risk factors, including diabetes mellitus [10,11,15]. Recent guidelines proposed a careful metabolic monitoring in patients with schizophrenia and schizoaffective disorders, especially those receiving atypical antipsychotics [1,[19][20][21].…”

Section: Introductionmentioning

confidence: 99%

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Abnormal glucose metabolism in patients treated with antipsychotics

Scheen

Hert

2007

Diabetes & Metabolism

148

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Second-generation (atypical) antipsychotic medications are of great benefit to a wide variety of people with psychiatric disorders, especially patients with schizophrenia. However, one constellation of adverse effects is an increased risk of obesity, diabetes, and metabolic syndrome. Increasing numbers of reports concerning impaired glucose tolerance, diabetes, and ketoacidosis have raised concerns about a possible association between abnormal glucose metabolism and treatment with atypical antipsychotics, although the question is still debated because of the presence of many confounding factors. A close relationship between drug-induced weight gain and risk of diabetes has been reported, emphasizing the role of insulin resistance. However, some cases of diabetes developed independently of weight gain, rather rapidly and possibly progressing to ketoacidosis, thus arguing for a severe impairment of insulin secretion. Another debated question is whether diabetes risk is a class action or a differential action. Although not fully scientifically proven yet, available evidence suggests that clozapine and olanzapine have a higher propensity to induce diabetes and metabolic syndrome compared with other atypical antipsychotic drugs, risperidone and quetiapine. Despite more limited available data, amisulpride, aripiprazole and ziprazidone showed less likelihood of precipitating diabetes. Interestingly, reversibility of drugrelated diabetes has been reported with aripiprazole. The choice of atypical antipsychotic medication for a specific patient depends on many factors, but the likelihood of developing diabetes should become an important consideration. When prescribing an atypical antipsychotic, a commitment to careful baseline screening and follow-up monitoring is essential in order to mitigate the risk of developing diabetes and associated complications.Keywords: antipsychoticsa; schizophrenia ; diabetes ; impaired glucose tolerance ; metabolic syndrome ; review RésuméLes antipsychotiques de seconde génération, appelés aussi antipsychotiques atypiques, ont apporté une aide précieuse dans la prise en charge de nombreux patients psychiatriques, en particulier ceux avec schizophrénie. Cependant, ils semblent associés à une constellation d'effets indésirables métaboliques, avec un risque accru d'obésité, de diabète et de syndrome métabolique. Un nombre croissant de publications à propos de cas de diminution de tolérance au glucose, de diabète et d'acidocétose chez des patients traités avec des antipsychotiques atypiques plaident pour une association causale possible entre une anomalie du métabolisme du glucose et le traitement par antipsychotique atypique, même si la question reste controversée suite à la présence de nombreux facteurs confondants. Une relation étroite entre la prise de poids induite par la médication et le risque accru de diabète a été rapportée, insistant sur le rôle de l'insulinorésistance. Pourtant, certains cas de diabète se développent indépendamment de toute prise pondérale, avec une évolution...

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Screening for Diabetes and Other Metabolic Abnormalities in Patients with Schizophrenia and Schizoaffective Disorder: Evaluation of Incidence and Screening Methods

Cited by 33 publications

References 0 publications

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

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

Metabolic syndrome and lung function in schizophrenia: A pilot study

Abnormal glucose metabolism in patients treated with antipsychotics

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