Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta-analysis.
Type 2 diabetes mellitus (T2DM) is highly predictive of cardiovascular diseases and can have particularly deleterious health impacts in people with severe mental illness (SMI), i.e. schizophrenia, bipolar disorder or major depressive disorder. This meta-analysis aimed: a) to describe pooled frequencies of T2DM in people with SMI; b) to analyze the influence of demographic, illness and treatment variables as well as T2DM assessment methods; and c) to describe T2DM prevalence in studies directly comparing persons with each specific SMI diagnosis to general population samples. The trim and fill adjusted pooled T2DM prevalence among 438,245 people with SMI was 11.3% (95% CI: 10.0%-12.6%). In antipsychotic-naïve participants, the prevalence of T2DM was 2.9% (95% CI: 1.7%-4.8%). There were no significant diagnostic subgroup differences. A comparative meta-analysis established that multi-episode persons with SMI (N=133,470) were significantly more likely to have T2DM than matched controls (N=5,622,664): relative risk, RR=1.85, 95% CI: 1.45-2.37, p<0.001. The T2DM prevalence was consistently elevated in each of the three major diagnostic subgroups compared to matched controls. Higher T2DM prevalences were observed in women with SMI compared to men (RR=1.43, 95% CI: 1.20-1.69, p<0.001). Multi-episode (versus first-episode) status was the only significant predictor for T2DM in a multivariable meta-regression analysis (r(2) =0.52, p<0.001). The T2DM prevalence was higher in patients prescribed antipsychotics, except for aripriprazole and amisulpride. Routine screening and multidisciplinary management of T2DM is needed. T2DM risks of individual antipsychotic medications should be considered when making treatment choices.
KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.|KU Leuven - University of Leuven, Z.org KU Leuven, Kortenberg, Belgium.
Davy
D
Vancampfort
Zucker Hillside Hospital, Glen Oaks, NY, USA.|Hofstra North Shore LIJ School of Medicine, Hempstead, NY, USA.
Christoph U
CU
Correll
Zucker Hillside Hospital, Glen Oaks, NY, USA.
Britta
B
Galling
KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
Michel
M
Probst
KU Leuven - University of Leuven, Z.org KU Leuven, Kortenberg, Belgium.
Marc
M
De Hert
School of Psychiatry and Ingham Institute of Applied Medical Research, University of New South Wales, Sydney, Australia.
Philip B
PB
Ward
School of Psychiatry and Ingham Institute of Applied Medical Research, University of New South Wales, Sydney, Australia.
Simon
S
Rosenbaum
Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.
Fiona
F
Gaughran
Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.
John
J
Lally
Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.|Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.|Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
Brendon
B
Stubbs
Diabetes mellitus; antipsychotics; bipolar disorder; major depressive disorder; schizophrenia; severe mental illness