The epidemiology of diabetes in psychotic disorders

Ward, Martha C.; Druss, Benjamin G.

doi:10.1016/s2215-0366(15)00007-3

Cited by 129 publications

(118 citation statements)

References 123 publications

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“…A higher prevalence of comorbid conditions (e.g. diabetes and cardiovascular disease) and poorer management of physical health contribute to this health inequality [2]. Around 13% of people with SMI have diabetes compared with 6% of the general population, and the difference is increasing [3].…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis

et al. 2017

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People with severe mental illness (SMI) have reduced life expectancy compared with the general population, which can be explained partly by their increased risk of diabetes. We conducted a meta-analysis to determine the clinical effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in people with SMI (PROSPERO registration: CRD42015015558). A systematic literature search was performed on 30/10/2015 to identify randomised controlled trials (RCTs) in adults with SMI, with or without a diagnosis of diabetes that measured fasting blood glucose or glycated haemoglobin (HbA1c). Screening and data extraction were carried out independently by two reviewers. We used random effects meta-analysis to estimate effectiveness, and subgroup analysis and univariate meta-regression to explore heterogeneity. The Cochrane Collaboration’s tool was used to assess risk of bias. We found 54 eligible RCTs in 4,392 adults (40 pharmacological, 13 behavioural, one mixed intervention). Data for meta-analysis were available from 48 RCTs (n = 4052). Both pharmacological (mean difference (MD), -0.11mmol/L; 95% confidence interval (CI), [-0.19, -0.02], p = 0.02, n = 2536) and behavioural interventions (MD, -0.28mmol//L; 95% CI, [-0.43, -0.12], p<0.001, n = 956) were effective in lowering fasting glucose, but not HbA1c (pharmacological MD, -0.03%; 95% CI, [-0.12, 0.06], p = 0.52, n = 1515; behavioural MD, 0.18%; 95% CI, [-0.07, 0.42], p = 0.16, n = 140) compared with usual care or placebo. In subgroup analysis of pharmacological interventions, metformin and antipsychotic switching strategies improved HbA1c. Behavioural interventions of longer duration and those including repeated physical activity had greater effects on fasting glucose than those without these characteristics. Baseline levels of fasting glucose explained some of the heterogeneity in behavioural interventions but not in pharmacological interventions. Although the strength of the evidence is limited by inadequate trial design and reporting and significant heterogeneity, there is some evidence that behavioural interventions, antipsychotic switching, and metformin can lead to clinically important improvements in glycaemic measurements in adults with SMI.

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Section: Introductionmentioning

confidence: 99%

The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis

et al. 2017

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“…Insulin resistance is a major factor in the development of diabetes mellitus (Tang, Li, Song, & Xu, 2015), and inflammation plays a role in the pathogenesis of cardiovascular disease (Kanda & Takahashi, 2004;Ridker, Hennekens, Buring, & Rifai, 2000). These processes are highly relevant to schizophrenia, as this population has a high rate of obesity and cardiovascular disease (Azad et al, 2016;Ringen, Engh, Birkenaes, Dieset, & Andreassen, 2014;Ward & Druss, 2015), leading to increased morbidity and mortality relative to the general population. Although relationships have been discovered between PPFs, health variables, and blood-based biomarkers in other populations (i.e.…”

Section: Introductionmentioning

confidence: 99%

“…physical comorbidity, cardiovascular disease risk). We examined biomarkers of insulin resistance and inflammation due to their relevance to the health of persons with schizophrenia (Azad et al, 2016;Ringen et al, 2014;Ward & Druss, 2015), and because these two types of biomarkers have been found to be associated with positive psychological well-being and positive affect in other populations (Osama & Shehab Ael, 2015;Phillips & Perry, 2015;Steptoe et al, 2012;Steptoe et al, 2008). We hypothesized that the schizophrenia group would have lower mean levels of resilience, optimism, and happiness, and higher levels of perceived stress, relative to the HC group.…”

Section: Introductionmentioning

confidence: 99%

Positive mental health in schizophrenia and healthy comparison groups: relationships with overall health and biomarkers

Edmonds

Martin

Palmer

et al. 2016

Aging & Mental Health

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Positive mental health in schizophrenia and healthy comparison groups: relationships with overall health and biomarkers. Objective: Positive psychological factors (PPFs) have been reported to have a significant impact on health in the general population. However, little is known about the relationship of these factors with mental and physical health in schizophrenia. Method: One hundred and thirty-five outpatients with schizophrenia and 127 healthy comparison subjects (HCs), aged 26-65 years, were evaluated with scales of resilience, optimism, happiness, and perceived stress. Measures of mental and physical health were also obtained. Regression analyses examined associations of a PPF composite with health variables. Results: Relative to the HCs, the schizophrenia group had lower levels of PPFs. However, there was considerable heterogeneity, with over one-third of schizophrenia participants having values within the 'normative' range. The PPF composite was positively related to mental and physical health variables and with biomarkers of inflammation and insulin resistance. The relationship between PPFs and mental health was particularly strong for individuals with schizophrenia. Conclusion: A sizable minority of adults with chronic schizophrenia have levels of resilience, optimism, happiness, and perceived stress similar to HCs. Psychosocial interventions to enhance PPFs should be tested in patients with serious mental illnesses, with the goal of improving their mental health (beyond controlling symptoms of psychosis) and their physical health.

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“…Diabetes is prevalent among people with psychotic disorders such as schizophrenia and schizoaffective disorder, as well as adults with affective disorders including bipolar, depression and anxiety disorders (Ward & Druss, 2015). It is, however, difficult to estimate the prevalence with precision as diabetes is under-diagnosed in patients with psychotic disorders (Ward & Druss).…”

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confidence: 99%

“…Risk factors seem to have synergetic effects and include: use of antipsychotic medications; genetics and adverse determinants of health, such as poor housing or homelessness; poor access and utilization of health services; and poverty (Ward & Druss, 2015).…”

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confidence: 99%

Evaluation of a Diabetes Management Program for Persons with Serious and Persistent Mental Illness

Mwangi¹

2017

Preprint

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Clinical Practice Recommendations and Evidence-Based Guidelines for Integrated Care were used to evaluate a diabetes management program for persons with serious and persistent mental illness in an integrated primary and behavioral health care center in New England. A simple random method was used to select a sample of 25 medical records of patients with diabetes and at least one mental illness. Data on seven diabetes content areas offered to patients and biophysical measures of weight, body mass index

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The epidemiology of diabetes in psychotic disorders

Cited by 129 publications

References 123 publications

The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis

The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis

Positive mental health in schizophrenia and healthy comparison groups: relationships with overall health and biomarkers

Evaluation of a Diabetes Management Program for Persons with Serious and Persistent Mental Illness

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