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

Abstract

The levels of fasting glucose, fasting insulin, insulin resistance (IR) and the prevalence of metabolic syndrome (MS) in a sample population of bipolar disorder (BPD) patients who were newly diagnosed and psychotropically naïve were assessed and compared with an age, sex and racially matched control population. 55 BPD-I patients (15-65 years) who were non-diabetic, nonpregnant, and drug naïve for a period of at least 6 months were included in the study. Diagnosis was made using the structured clinical interview for DSM-IV axis I disorders (SCID IV). IR was assessed using homeostasis model of insulin resistance (HOMA-IR); MS was defined according to National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III). Data were compared with 25 healthy controls. BPD patients had significantly higher mean levels of fasting plasma insulin (13.2 ± 9.2 vs. 4.68 ± 3.1 lIU/ ml, p \ 0.05), postprandial plasma insulin (27.2 ± 14.5 vs. 18.1 ± 9.3 lIU/ml, p \ 0.05) and a higher value of HOMA-IR (3.16 ± 2.2 vs. 1.19 ± 0.8, p \ 0.05) when compared to the controls. A significantly higher proportion of patients of BPD compared to controls were manifesting levels of fasting plasma glucose, serum triglyceride and blood pressure higher than the cut off while waist circumference and serum HDL cholesterol failed to show any significant difference in the proportion. There was a significantly higher proportion of prevalence of IR between BPD cases and controls (26/55 vs. 2/25, z value 9.97, p \ 0.05) while there was no significant difference in proportion of prevalence of MS between these two groups. Within BPD patients, logistic regression analysis showed that age, sex or current mood status (depressed/ manic) were not significantly predictive of presence or absence of MS or increased IR.

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

“…In patients with FEP, our cumulative analyses on glucose metabolism outcomes are in line with previous meta‐analyses, which showed significant increases in fasting insulin levels and impaired oral glucose tolerance in this patient population (Greenhalgh et al, ; Perry et al, ; Pillinger et al, ). Our meta‐analysis also confirms previous reports of an impaired oral glucose tolerance in first episode, treatment‐naïve patients with mood disorders (Garcia‐Rizo et al, ; Guha et al, ). Previous studies mostly focused on a specific diagnosis of SMIs, particularly FEP, while only one study compared the differences on glucose metabolism outcomes between various SMIs (Garcia‐Rizo et al, ).…”

“…Epidemiological studies have indicated higher DM2 incidence, as well as increased insulin resistance in patients with bipolar disorder and depression (Calkin et al, 2013;Charles, Lambert, & Kerner, 2016;Fagiolini, Frank, Scott, Turkin, & Kupfer, 2005;McIntyre et al, 2005;Roy & Lloyd, 2012). Furthermore, findings in treatment-naïve first episode patients with bipolar disorder (Garcia-Rizo et al, 2016; Guha et al, 2014) and depression (Chang et al, 2013;Garcia-Rizo et al, 2013) indicated impaired glucose tolerance, insulin resistance and increased rates of DM2, similar as FEP patients. Impaired glucose metabolism may thus be a non-specific finding common to SMIs near illness onset.…”

DNA methylation, insulin resistance and second-generation antipsychotics in bipolar disorder

“…A further explanation for the highly elevated HOMA-IR values seen in this study could be the already elevated insulin resistance seen in medication-naive bipolar disorder. Guha and colleagues compared insulin resistance and metabolic syndrome components in a cohort of newly diagnosed, medication-naive bipolar I subjects to healthy controls [46] . The authors showed that insulin resistance was significantly higher in the bipolar disorder subjects compared with controls (HOMA-IR 3.16 vs 1.19, respectively) and that HOMA-IR was not predicted by age, sex, waist circumference or mood status.…”

Is Mania the Hypertension of the Mood? Discussion of A Hypothesis

“…At the same time the type of current mood episode in bipolar disorder was not predictive of the presence of metabolic syndrome or insulin resistance [150]. …”