title: Impaired glucose metabolism moderates the course of illness in bipolar disorder.
abstract: BACKGROUND
  The longitudinal course of bipolar disorder (BD) is highly heterogeneous, and is moderated by the presence of general medical comorbidities. This study aimed to investigate the moderating effects of impaired glucose metabolism (IGM) on variables of illness course and severity in a BD population.
  
  
  METHODS
  Fifty-five patients with BD were evaluated. All subjects were evaluated with respect to current and past psychiatric and medical disorders, as well as lifetime use of any medication. Body mass index (BMI) and metabolic parameters were obtained. IGM was operationalized as pre-diabetes or type 2 diabetes mellitus.
  
  
  RESULTS
  Thirty (54.5%) individuals had IGM. After adjustment for age, gender, ethnicity, alcohol use, smoking, BMI and past and current exposure to psychotropic medications, individuals with IGM, when compared to euglycemic participants, had an earlier age of onset (RR: 0.835, p=0.024), longer illness duration (RR: 1.754, p=0.007), a higher number of previous manic/hypomanic episodes (RR: 1.483, p=0.002) and a higher ratio of manic/hypomanic to depressive episodes (RR: 1.753, p=0.028). Moreover, we observed a moderating effect of IGM on the association between number of mood episodes and other variables of illness course, with the correlation between lifetime mood episodes and frequency of episodes being significantly greater in the IGM subgroup (RR: 1.027, p=0.029). All associations observed herein remained significant after adjusting for relevant confounding factors (e.g. age, alcohol and tobacco use, exposure to psychotropic agents, BMI).
  
  
  CONCLUSIONS
  Cross-sectional design, small sample size.
  
  
  CONCLUSIONS
  Comorbid IGM may be a key moderator of illness progression in BD.
authors: Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada. Electronic address: rodrigomansur71@uol.com.br.
authors: Rodrigo B
authors: RB
authors: Mansur
authors: Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Department of Psychiatry, Clinic for Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.
authors: Lucas B
authors: LB
authors: Rizzo
authors: Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
authors: Camila M
authors: CM
authors: Santos
authors: Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
authors: Elson
authors: E
authors: Asevedo
authors: Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
authors: Graccielle R
authors: GR
authors: Cunha
authors: Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Vila Maria Outpatient Clinic in São Paulo, Brazil.
authors: Mariane N
authors: MN
authors: Noto
authors: Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
authors: Mariana
authors: M
authors: Pedrini
authors: Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
authors: Maiara
authors: M
authors: Zeni
authors: Department of Psychiatry, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), Brazil.
authors: Quirino
authors: Q
authors: Cordeiro
authors: Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada.
authors: Roger S
authors: RS
authors: McIntyre
authors: Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
authors: Elisa
authors: E
authors: Brietzke
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy / Q000378:metabolism*; D015992:Body Mass Index; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism*; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011619:Psychotropic Drugs / Q000627:therapeutic use
chemical_list: D011619:Psychotropic Drugs; D005947:Glucose
keywords: Bipolar disorder; Course; Diabetes; Impaired glucose metabolism; Progression