Mechanisms in endocrinology: Antipsychotic medication and type 2 diabetes and impaired glucose regulation

Whicher, Clare; Price, Hermione; Holt, Richard

doi:10.1530/eje-18-0022

Cited by 36 publications

(27 citation statements)

References 60 publications

(78 reference statements)

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“…In this study, 24.9% (95% CI: 19.4-30.4) of psychiatric patients had prediabetes/impaired fasting glucose and this in line with the study conducted in Southwest Ethiopia, which was 26.9% [28]. However, low rates were reported by different studies, like 4% [40] and 7% [41]. The differences might be attributed to the individuals' lifestyle, the diagnostic variability and the scale/guideline that applied to define hyperglycemia (National cholesterol education adult treatment panel III vs. the American Diabetes Association).…”

Section: Discussionsupporting

confidence: 88%

The magnitude of undiagnosed diabetes and Hypertension among adult psychiatric patients receiving antipsychotic treatment

Hirigo

Teshome

2020

Diabetol Metab Syndr

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Background Patients with severe mental illness (SMI) are at increased risk of developing non-communicable diseases that could cause significantly lower life expectancy when compared to the general population. This study aimed to assess the magnitude and predictors of undiagnosed type-2 diabetes and hypertension among adult patients with SMI on antipsychotic treatments. Methods A hospital-based cross-sectional study was conducted on 237 psychiatric patients from January to June 2019 at Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia. All relevant information was collected using a structured interviewer-administered questionnaire with a systematic random sampling technique. A total of 4–5 mL of overnight fasting venous blood was collected from each patient. Serum lipid profiles and fasting blood sugar (FBS) were measured using the A25™ BioSystem Random Access chemistry analyzer. To identify predictors of hyperglycemia and raised blood pressure, multiple linear regression analysis was done using SPSS version 23. Statistical significance was set at p value < 5%. Results From 247 patients with SMI approached, 237 (58.2% male and 41.8% females) were take part in the study giving a response rate of 95.9%. The overall 31.2% (95%CI: 24.1–37.6) and 27.8% (95%CI: 23.2–33.4) of patients had hyperglycemia and raised BP. The magnitude of prediabetes and type-2 diabetes was 24.9% (95%CI:19.4–30.4), and 6.3% (95% CI: 3.4–10.1), respectively. While the magnitude of prehypertension and hypertension was 23.2% (95%CI: 17.3–29.5) and 4.6% (95%CI: 2.1–8.0), respectively. In multiple linear regression analyses: age, HDL-cholesterol, physical activity and Triglyceride/HDL-cholesterol ratio were positively correlated with FBS. While, HDL-cholesterol, waist circumference, physical activity, total cholesterol/HDL-c ratio, and body mass index were positively correlated with systolic and diastolic blood pressures. Conclusion The findings indicate a need to assess blood glucose and blood pressure at baseline before the commencement of any antipsychotic therapy and during therapeutic follow up to manage any increasing trends. Moreover, close monitoring of patients with severe mental illness on antipsychotic therapy is exclusively recommended.

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Section: Discussionsupporting

confidence: 88%

The magnitude of undiagnosed diabetes and Hypertension among adult psychiatric patients receiving antipsychotic treatment

Hirigo

Teshome

2020

Diabetol Metab Syndr

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“…Mechanisms underlying antipsychotic-induced diabetes are not well understood and possibly depend on multifactorial processes 16,17. Related genetic polymorphisms may explain the occurrence of hyperglycemia in some patients but not others.…”

Section: Introductionmentioning

confidence: 99%

Association between polymorphisms of LEP, LEPR, DRD2, HTR2A and HTR2C genes and risperidone- or clozapine-induced hyperglycemia

Puangpetch

Srisawasdi

Unaharassamee

et al. 2019

PGPM

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Objective To determine whether genetic polymorphisms related to pharmacodynamics with metabolic adverse effects, namely leptin promoter ( LEP ) rs7799039, leptin receptor rs1137101, dopamine D2 rs4436578, serotonin 5-HT2A rs6313, and serotonin 5-HT2C rs518147 and rs12836771, are associated with hyperglycemia induced by risperidone or clozapine in adult Thai patients with psychosis. Methods A total of 180 patients treated with risperidone-based ( n =130) or clozapine-based ( n =50) regimens were included in this study. Blood samples were analyzed for genotyping of the candidate genes and biochemical testing. Genotyping was performed by conducting a TaqMan real-time polymerase chain reaction-based analysis. Results The prevalence of hyperglycemia was higher in patients receiving clozapine (64.0%) than in those receiving risperidone (30.8%). Among the candidate genes, only the LEP rs7799039 polymorphism demonstrated a significant association with hyperglycemia (χ 2 =9.879, P =0.008) in patients treated with risperidone; patients with the AA genotype had the highest risk (41.1%), followed by those with AG (20.8%) and GG (0%) genotypes. Using the recessive genetic model (AA vs AG + GG), the odds ratio and 95% CI were 3.28 and 1.44 −7.50, respectively. None of the genes were associated with hyperglycemia in patients treated with clozapine. A binary logistic regression revealed that the LEP rs7799039 polymorphism demonstrated a significant association with hyperglycemia, independent of body-mass index (BMI) in patients receiving risperidone; the odds ratio (95% CI) was 3.188 (1.399–7.262), P =0.006. By contrast, none of the pharmacodynamic genetic factors, except for BMI, were significantly associated with hyperglycemia in patients receiving clozapine. Conclusion The risk of type 2 diabetes mellitus is associated with the LEP rs7799039 polymorphism in Thai adults receiving risperidone but not in those receiving clozapine. Clarifying underlying mechanisms and risk of hyperglycemia provides an opportunity to prevent impaired glucose metabolism in patients receiving risperidone or clozapine.

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“…Although an association seems to exist between antipsychotic medication and DM, further research is needed to understand how these medications cause DM ( 93 , 98 ). The estimated prevalence of DM in antipsychotic-naïve patients is 2.9%, which is substantially lower than in patients treated with antipsychotics except for aripiprazole and amisulpride.…”

Section: Diabetes Mellitusmentioning

confidence: 99%

Impact of Psychotropic Medication Effects on Obesity and the Metabolic Syndrome in People With Serious Mental Illness

et al. 2020

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People with serious mental illness (SMI), including schizophrenia, bipolar disorder, and major depressive disorder, have a higher mortality rate and shortened life expectancy. This is mainly attributable to physical diseases, particularly cardiovascular diseases (CVDs). Important risk factors for CVDs are obesity and other metabolic abnormalities, which are especially prevalent in people with SMI. Several factors contribute to this increased risk, including unhealthy lifestyles. Psychotropic medication independently further increases this risk. In this review we want to examine the relationship between obesity and other components of the metabolic syndrome and psychotropic medication in people with SMI.

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Mechanisms in endocrinology: Antipsychotic medication and type 2 diabetes and impaired glucose regulation

Cited by 36 publications

References 60 publications

The magnitude of undiagnosed diabetes and Hypertension among adult psychiatric patients receiving antipsychotic treatment

The magnitude of undiagnosed diabetes and Hypertension among adult psychiatric patients receiving antipsychotic treatment

<p>Association between polymorphisms of <em>LEP</em>,<em> LEPR</em>, <em>DRD2</em>, <em>HTR2A</em> and<em> HTR2C</em> genes and risperidone- or clozapine-induced hyperglycemia</p>

Impact of Psychotropic Medication Effects on Obesity and the Metabolic Syndrome in People With Serious Mental Illness

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