Prevalence of type 2 diabetes in psychiatric disorders: an umbrella review with meta-analysis of 245 observational studies from 32 systematic reviews

Abstract

Aims/hypothesis Estimates of the global prevalence of type 2 diabetes vary between 6% and 9%. The prevalence of type 2 diabetes has also been investigated in psychiatric populations, but a critical appraisal of the existing evidence is lacking, and an overview is needed. This umbrella review summarizes existing systematic reviews of observational studies investigating the prevalence of type 2 diabetes in people with a psychiatric disorder. MethodsWe searched PubMed, EMBASE, PsycINFO and Cochrane Database of Systematic Reviews from inception to January 17, 2021, and screened reference lists of included systematic reviews. Based on prespecified criteria we included systematic reviews investigating prevalence of type 2 diabetes in adults (≥18years) with a psychiatric disorder. Title and abstracts of 5,155 identified records and full text of 431 selected studies were screened by two independent reviewers, based on predefined eligibility criteria and an a priori developed extraction form, following the PRISMA and MOOSE guidelines. Risk of bias was assessed with the ROBIS instrument. Data extracted from primary studies were synthesized using random-effects metaanalyses.Results A total of 32 systematic reviews with 245 unique primary studies were identified and met inclusion criteria. Of them, 12 had low risk of bias. They reported type 2 diabetes prevalence estimates ranging from 5% to 22% depending on the specific psychiatric disorder. We meta-analyzed data for ten categories of psychiatric disorders and found prevalence estimates of type 2 diabetes varying between 8% to 40%: 40% among people with sleep disorders, 21% in binge eating disorders, 16% in substance use disorders, 14% in anxiety disorders, 11% in bipolar disorders, 11% in psychosis, 10% in schizophrenia, 10% in a mixed group of psychiatric disorders, 9% in depression, and 8% in intellectual disabilities. All meta-analyses revealed high levels of heterogeneity. Conclusions/interpretationType 2 diabetes is a common comorbidity in people with a psychiatric disorder.Future research should investigate whether routine screening for type 2 diabetes and subsequent prevention initiatives for these people are warranted. PROSPERO registration no: CRD42020159870How might this impact on clinical practice in the foreseeable future?• Type 2 diabetes is a common comorbidity in individuals with psychiatric disorders. Future research should evaluate whether diabetes screening is warranted and whether diabetes treatment targets are currently met in this group.

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“…People with T2DM more broadly are known to be at elevated risk of psychopathology and disordered eating [14]. A recent umbrella review identifi ed 32 systematic reviews with 245 primary studies of people with T2DM and measures of psychopathology [14]. They revealed the high prevalence rates of psychopathology for people with T2DM: 40% sleep disorder, 21% binge eating disorder, 16 % substance use disorder, 14% anxiety-related disorder, 11% bipolar disorder, 11% psychosis, 9% depression [14].…”

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