title: Altered metabolic parameters in association with antipsychotic medication use in diabetes: A population based case-control study.
abstract: OBJECTIVE
  This study assess differences in clinical variables in diabetes patients prescribed antipsychotic medication and determines relative schizophrenia prevalence in the diabetes population.
  
  
  METHODS
  This population-based case-control study utilizing Scotland's national diabetes registry (SCI-diabetes) and linked psychiatric hospital discharge data (SMR04) established diabetes phenotypes in a patient cohort prescribed long term antipsychotic medication (n=2362) (cases). Cases were matched 1:10 to diabetes patients not prescribed antipsychotic medication (controls) for BMI, gender; diabetes type; birth year; diagnosis date; smoking status. Sub-groups with defined schizophrenia (n=196) or bipolar disorder (n=190) were further examined. Schizophrenia prevalence in the diabetes versus general population was compared.
  
  
  RESULTS
  During follow up, antipsychotic prescription was associated with lower HbA1c (55.1 (95% CI 54.5-55.8) or 7.2 (95% CI 7.1-7.3)% vs 58.2 (58.0-58.4) mmol or 7.5 (95% CI 7.5-7.5)% p<0.001) lower serum total cholesterol, 4.2 (4.1-4.2) vs 4.3 (4.2-4.3) mmol/l, p<0.001, lower blood pressure (systolic 130 (130.17-131.29) vs 134 (134.3-134.7) mmHg, p<0.001), higher prescription of oral hypoglycaemic medication (42% (40-45) vs 38% (37-39) p<0.001), similar statin prescriptions (85% (81-89) vs 85% (84-86), p=0.55), and lower retinopathy rates (28% (25.6-30.5) vs 32% (31.5-33.1), p<0.001). HbA1c at diagnosis was similar (p=0.27). Schizophrenia prevalence was higher in the diabetes versus general population with differences across age groups (Scottish population versus diabetic population rate of 522.2 (522.1-522.3) versus 717.4 (703.4-731.9) per 100,000).
  
  
  CONCLUSIONS
  We confirm higher diabetes rates in schizophrenia up to age 70, similar attendance rates and clinical measurements that are not worse in a large well-matched population-based Scottish sample prescribed antipsychotic medication versus matched general diabetes patients.
authors: School of Medicine, University of Dundee, United Kingdom. Electronic address: d.j.wake@dundee.ac.uk.
authors: D J
authors: DJ
authors: Wake
authors: Data Analyst, School of Medicine, University of Dundee, United Kingdom.
authors: P
authors: P
authors: Broughton
authors: School of Medicine, University of Dundee, United Kingdom.
authors: S M
authors: SM
authors: Perera
authors: Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom.
authors: D J
authors: DJ
authors: MacIntyre
authors: Department of Diabetes, NHS Tayside, Ninewells Hospital, Dundee, United Kingdom.
authors: G P
authors: GP
authors: Leese
mesh_terms: D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy / Q000453:epidemiology; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000453:epidemiology* / Q000378:metabolism / Q000523:psychology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotics; Case-control; Diabetes; Mental health; Metabolic; Schizophrenia