Screening for diabetes and other metabolic abnormalities in patients with schizophrenia and schizoaffective disorder: evaluation of incidence and screening methods.
OBJECTIVE
To assess the diagnostic properties of 2 different screening guidelines for the detection of diabetes in patients diagnosed with schizophrenia.


METHODS
Over a 2-year period (November 2003-November 2005), 415 patients with schizophrenia were screened with a full laboratory screening and a 75-g oral glucose tolerance test (OGTT). The sensitivity of 2 screening strategies was compared with the "gold standard": the OGTT. The 2 strategies were (1) assessing fasting glucose in all patients, as suggested by the American Psychiatric Association/ American Diabetes Association (APA/ADA), and (2) a screening strategy derived from the guidelines of the World Health Organization of assessing fasting glucose in all patients (step 1) and subsequently performing an OGTT in patients with impaired fasting glucose (step 2).


RESULTS
Of the total sample, 6.3% (N = 26) met criteria for diabetes, resulting in a mean annual incidence of diabetes of 3.15% (6.3% incident cases/2 years). A screening based on the APA/ADA guidelines detected diabetes in 12 (46.2%) of the 26 cases identified by the OGTT. The proposed 2-step strategy detected 25 (96.2%) of 26 cases.


CONCLUSIONS
The data suggest a high incidence of diabetes in patients diagnosed with schizophrenia. However, the guidelines to detect diabetes as proposed by the APA/ADA did not sufficiently detect diabetes in this specific high-risk group. The alternative 2-step strategy was able to detect the vast majority of diabetes cases and should therefore be considered in the clinical routine of screening and monitoring patients with schizophrenia.
van Winkel
Ruud
R
University Psychiatric Center, Katholieke Universiteit Leuven, Kortenberg, Belgium.
De Hert
Marc
M
Van Eyck
Dominique
D
Hanssens
Linda
L
Wampers
Martien
M
Scheen
Andre
A
Peuskens
Joseph
J
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001530:Belgium / Q000453:epidemiology; D001786:Blood Glucose / Q000032:analysis*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D005069:Evaluation Studies as Topic; D005215:Fasting / Q000097:blood; D005260:Female; D005951:Glucose Tolerance Test / Q000592:standards / Q000706:statistics & numerical data; D017408:Guidelines as Topic / Q000592:standards; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D024821:Metabolic Syndrome / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D011618:Psychotic Disorders / Q000097:blood* / Q000453:epidemiology*; D012559:Schizophrenia / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology*; D012680:Sensitivity and Specificity; D012955:Societies, Medical / Q000592:standards; D014837:Voluntary Health Agencies / Q000592:standards; D014944:World Health Organization
D014150:Antipsychotic Agents; D001786:Blood Glucose