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Schizophrenia, antipsychotics individually increase risk for diabetes

Schizophrenia was associated with a significantly increased risk for diabetes, which further increased with use of first- and second-generation antipsychotics.

“The prevalence of diabetes mellitus is four to five times higher among people with schizophrenia than in the general population. Those who suffer from both diabetes and schizophrenia have a three- to fourfold higher overall mortality rate than the general population, and at least one-third of those deaths can be attributed to diabetes,” Anto P. Rajkumar, MD, DNB, MRCPsych, PhD, of King’s College London, and colleagues wrote.

To assess endogenous risk for diabetes before and after starting antipsychotics for schizophrenia, researchers followed all individuals born in Denmark from 1977 to 2013 (n = 2,736,510). Schizophrenia, antipsychotic prescriptions and diabetes were determined via the Danish Psychiatric Central Research Register, Danish National Prescription Registry, and Danish National Patient Register.

Overall, 0.52% of participants developed diabetes and 0.33% developed schizophrenia.

Among antipsychotic-naïve individuals with schizophrenia, adjusted hazard ratio for diabetes was 3.07 (95% CI, 1.71-5.41).

Risk for diabetes significantly increased after initiating antipsychotic treatment (aHR = 3.64; 95% CI, 1.95-6.82), when adjusting for family history of diabetes and other confounders.

First-line treatment with first-generation antipsychotics (aHR = 3.06; 95% CI, 1.32-7.05) or second-generation antipsychotics (aHR = 3.44; 95% CI, 1.73-6.83) increased risk for diabetes, but was not statistically significant.

Sensitivity analyses limited to type 2 diabetes reaffirmed these associations.

“Psychiatric services should either develop specific protocols or closely collaborate with primary care facilities to screen for diabetes among people with schizophrenia in the community. Promoting a healthy lifestyle, early detection by regular, at least yearly, screening, and effective treatment of diabetes should be integral parts of multidisciplinary management of schizophrenia,” the researchers concluded. – by Amanda Oldt

Disclosure: Rajkumar reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.