ArticlesEffect of age, family history of diabetes, and antipsychotic drug treatment on risk of diabetes in people with psychosis: a population-based cross-sectional study
Introduction
Schizophrenia is associated with an increased risk of type 2 diabetes.1, 2, 3 Risk increases with age and in association with a family history of diabetes and antipsychotic drug treatment.4, 5, 6 Sernyak and colleagues7 postulated an accelerated risk of diabetes in psychosis because of synergy between medication and pre-existing liability that serves to hasten onset in those already at increased risk. We aimed to assess whether age, family history of diabetes, and antipsychotic drug treatment were independent predictors of type 2 diabetes in people with psychosis and whether their interactions masked substantial heterogeneity in risk in a national sample of adults with psychosis.
Section snippets
Data source and study population
The Australian National Survey of Psychosis8, 9 is a population-based cross-sectional study of people with psychosis aged 18–64 years ascertained from seven mental health service sites in five Australian states, covering an estimated resident population aged 18–64 years of 1 464 923 people—about 10% of Australians in that age range. The survey design and methods have been described in detail elsewhere.8, 9 Briefly, the study sample comprised people aged 18–64 years who were resident in the
Results
The mean age of participants in the sample was 38·4 years (SD 11·0), 489 (42%) were aged 18–34 years and 666 (58%) were aged 35–64 years; 711 (62%) were men (table 1). Those with current type 2 diabetes were more likely to be in the older age group (p<0·0001), have a family history of diabetes (p<0·0001), and be currently treated with clozapine (p=0·019; table 1).
996 (86%) of 1155 participants were currently being prescribed antipsychotic drugs and 853 (74%) were currently being prescribed one
Discussion
In this study, antipsychotic drug treatment was associated with an increased risk of type 2 diabetes only in those without a family history of diabetes. Age was an independent risk factor. Therefore, the risk of type 2 diabetes that until now has been attributed to antipsychotic drug effects alone is likely to be overestimated in those with a family history of diabetes and underestimated in those without a family history of diabetes. The effects of some antipsychotic drugs on risk of diabetes
References (19)
- et al.
Schizophrenia and diabetes: epidemiological data
Eur Psychiatry
(2005) - et al.
Phenothiazine neuroleptics signal to the human insulin promoter as revealed by a novel high-throughput screen
J Biomol Screen
(2010) - et al.
Endogenic and iatrogenic diabetes mellitus in drug-naive schizophrenia: the role of olanzapine and its place in the psychopharmacological treatment algorithm
Neuropsychopharmacology
(2011) - et al.
Diabetes mellitus and severe mental illness: mechanisms and clinical implications
Nat Rev Endocrinol
(2015) - et al.
Predictors of type 2 diabetes in a nationally representative sample of adults with psychosis
World Psychiatry
(2014) - et al.
Antipsychotics associated with the development of type 2 diabetes in antipsychotic-naive schizophrenia patients
Neuropsychopharmacology
(2010) - et al.
The incidence of diabetes in atypical antipsychotic users differs according to agent—results from a multisite epidemiologic study
Pharmacoepidemiol Drug Saf
(2009) - et al.
Association of diabetes mellitus with use of atypical neuroleptics in the treatment of schizophrenia
Am J Psychiatry
(2002) - et al.
People living with psychotic illness in 2010: the second Australian National Survey of Psychosis
Aust N Z J Psychiatry
(2012)
Cited by (25)
Predicting type 2 diabetes prevalence for people with severe mental illness in a multi-ethnic East London population
2023, International Journal of Medical InformaticsParental history of diabetes mellitus has additive risk of metabolic syndrome in patients treated with clozapine
2020, Asian Journal of PsychiatryMeta-analysis of comorbid diabetes and family history of diabetes in non-affective psychosis
2020, Schizophrenia ResearchCitation Excerpt :However, it is important to emphasize that patients without a family history of DM2 are also vulnerable to the diabetogenicity of some antipsychotics. For example, a large, Australian study found that in subjects with psychosis but without a family history of diabetes, any antipsychotic treatment was associated with a 4.4-fold increased risk of diabetes compared to no treatment (Foley et al., 2015). Given that adjunctive treatment with agents such as metformin (de Silva et al., 2016) and topiramate (Correll et al., 2016) may decrease body weight/BMI and insulin resistance in schizophrenia, a family history of DM2 may moderate these associations.
Risk of bias in observational studies of interventions: The case of antipsychotic-induced diabetes
2016, The Lancet PsychiatryAntipsychotic Drugs
2016, Side Effects of Drugs AnnualCitation Excerpt :A cross-sectional study (n = 174) found monotherapy with clozapine, olanzapine, or quetiapine was associated with metabolic syndrome (MetS), compared to monotherapy with risperidone or monotherapy with aripiprazole or ziprasidone [43c]. An Australian, observational study (n = 1155, 18–64 years) in patients with psychosis found an increased risk of DM with AP treatment (clozapine, quetiapine, aripiprazole, risperidone, olanzapine) in those patients without a family history of DM [44C]. A meta-analysis found that all individual APs were associated with a significantly higher MetS risk compared to the antipsychotic-naïve [45M].