Diabetes mellitus and mental illness

Prevalence of diabetes mellitus in chronic schizophrenic inpatients in relation to long-term antipsychotic treatment

BACKGROUND

Many reports indicate that the incidence and prevalence of diabetes mellitus is increased in schizophrenic patients and related to antipsychotic treatment. In an exploratory cross-sectional study we assessed the prevalence of type 2 diabetes mellitus in 266 chronic schizophrenic and schizoaffective inpatients and investigated whether the duration of antipsychotic treatment was related to the development of diabetes mellitus.

METHOD

We measured the non-fasting plasma glucose level in 266 inpatients with DSM IV diagnosis of schizophrenia or schizoaffective disorder in 5 different long-stay wards in the Netherlands. Measured variables were: age, sex, ethnicity, BMI, current antipsychotic treatment, duration of illness and duration of antipsychotic treatment.

RESULTS

The overall prevalence of type 2 diabetes mellitus was 9%, which is significantly higher than the prevalence of 4.9% in the general population (OR 1.89, CI 1.14-3.13; p<0.014). The prevalence was increased in two age cohorts: 30-39 years (3.8% vs. 0.3%, OR=13.29, CI=2.17-81.36, p=<0.005) and 40-49 years (9.3% vs. 1.5%, OR=6.74, CI=2.77-16.38, p=0.000). No new cases of diabetes mellitus were detected during the course of the study. The increased prevalence was found to be related to overweight and obesity. The time of exposure to antipsychotic treatment was not significantly correlated with the prevalence of diabetes mellitus when adjusted for age (F=0.804, df=1, p=0.371, respectively, F=0.194, df=1, p=0.660). Both typical and atypical antipsychotics contributed equally to the prevalence of diabetes mellitus.

CONCLUSION

No significant relation between long-term antipsychotic treatment and prevalence of diabetes mellitus was found. The high prevalence of diabetes mellitus in schizophrenic patients warrants screening of these patients already at young age for glucose disturbance.

Type 2 diabetes and depressive symptoms in older adults: a population-based study

The prevalence of depressive symptoms and its association with Type 2 (non-insulin-dependent) diabetes was examined in a population-based study of 1586 men and women aged 50 years or older. Men and women with previously diagnosed diabetes had significantly higher mean Beck Depression Inventory total, somatic subscale, and affective subscale scores than normal men and women and individuals with newly diagnosed diabetes. The age- and sex-adjusted rates of Inventory scores of 13 or greater among individuals with previously diagnosed diabetes was 3.7 times greater than the rates among individuals with newly diagnosed diabetes (p less than 0.05). Medication use and fasting plasma glucose were unrelated to symptom score. The number of other chronic conditions and age were significant independent predictors of depressive symptoms in all diabetic men and women. Results suggest that depressive symptoms in individuals with Type 2 diabetes may be related to awareness of diabetic condition in addition to poor health.

Psychiatric disorders and diabetes--results from a community study

In the Upper Bavarian Field Study a total of 1536 persons (15 years and older) were interviewed by research psychiatrists. The prevalence of diabetes (ICD 250) identified by the interviewer and/or the primary care physician was 4.0%. Since the number of diabetics among the younger age groups was relatively low (n = 7) and in order to obtain a more homogeneous study group, only those over the age of 55 were considered in further analysis. Diabetics were compared with a control group of persons with another chronic medical condition of similar clinical severity and a control group without a somatic disorder. The sex- and age-adjusted prevalence of psychiatric disorders identified with the aid of the Clinical Interview Schedule was significantly higher among diabetics (43.1%) and persons with other chronic medical conditions (50.7%) in comparison to the healthy control group (26.2%). The difference was mainly due to mild psychiatric disorders and those suffering from depression. No statistically significant association was found between diabetes and moderate to severe mental disorders, the use of psychotropic drugs and previous psychiatric treatment.

Depression and diabetes

The incidence and prevalence of depression in diabetic patients in the United Kingdom is unknown. Since depression may influence blood glucose control which in turn may be related to the development of diabetic complications, it is important to estimate its prevalence in diabetic patients. The prevalence of depression was investigated in a group of Caucasian and West Indian, insulin-(IDDM) and non-insulin-dependent (NIDDM) adult diabetics and a non-diabetic comparison group. Prevalence of depression was 8.5% for both groups and a further 19.2% and 14.6%, respectively, had borderline depression. Presence of depression was unrelated to sex, ethnic group, duration or type (IDDM or NIDDM) of diabetes and social class but significantly related to type of accommodation, marital status, and amount of social contact. A higher percentage of diabetics with psychiatric symptoms had one or more current complications compared to 'normal' diabetics. Diabetics suffer from a similar amount of depression to non-diabetics, but psychiatric symptoms may be related to the frequency of diabetic complications.