Elsevier

The Lancet Psychiatry

Volume 2, Issue 12, December 2015, Pages 1092-1098
The Lancet Psychiatry

Articles
Effect of age, family history of diabetes, and antipsychotic drug treatment on risk of diabetes in people with psychosis: a population-based cross-sectional study

https://doi.org/10.1016/S2215-0366(15)00276-XGet rights and content

Summary

Background

Psychosis is associated with an increased risk of diabetes mellitus. A positive synergy between antipsychotic drug effects and a pre-existing liability to diabetes mellitus might explain the especially high relative risk of diabetes mellitus in young adults with psychosis. We aimed to assess the individual and joint effect of age, family history of diabetes mellitus, and currently prescribed antipsychotic drug treatment on risk for diabetes mellitus.

Methods

In this study, we used data from the 2010 Australian National Survey of Psychosis—an observational study done at seven sites in five Australian states. We included data from 1155 people with psychosis aged 18–64 years who were in contact with psychiatric services and who gave a fasting blood sample to test for current diabetes mellitus. Using logistic regression, we modelled the association of diabetes mellitus with age, family history of diabetes mellitus, and current antipsychotic drug treatment. We compared model fit with and without two-way and three-way interaction terms and used likelihood ratio tests to establish which terms to include in the final model.

Findings

After adjustment for older age, which was an independent risk factor, compared with not taking antipsychotic drugs, antipsychotic drug treatment was associated with diabetes mellitus only in those without a family history of diabetes mellitus (clozapine adjusted odds ratio [OR] 7·22, 95% CI 1·62–32·20, p=0·01; quetiapine 5·91, 1·33–26·30, p=0·02; aripiprazole 5·06, 0·86–29·64, p=0·07; risperidone 4·17, 0·90–19·24, p=0·07; and olanzapine 2·23, 0·45–11·06, p=0·32). Antipsychotic drug treatment was not associated with additional risk of diabetes mellitus in those with a family history (clozapine adjusted OR 1·51, 95% CI 0·64–3·54, p=0·34; quetiapine 1·09, 0·49–2·43, p=0·82; aripiprazole 0·43, 0·12–1·49, p=0·18; risperidone 1·12, 0·48–2·63, p=0·79; and olanzapine 0·67, 0·26–1·71, p=0·39).

Interpretation

People with psychosis are at increased risk of diabetes mellitus if they have a family history of diabetes mellitus or if they have no family history of diabetes mellitus but are taking antipsychotic drugs. Increasing age increases risk but independently of family history or antipsychotic drug treatment. Clinicians should not think the absence of a family history of diabetes mellitus protects their patients from the diabetic side-effects of antipsychotics.

Funding

Australian Federal Government and Orygen.

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

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