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Scheuer SH, Andersen GS, Carstensen B, Diaz L, Kosjerina V, Lindekilde N, Wild SH, Jackson CA, Pouwer F, Benros ME, Jørgensen ME. Trends in Incidence of Hospitalization for Hypoglycemia and Diabetic Ketoacidosis in Individuals With Type 1 or Type 2 Diabetes With and Without Severe Mental Illness in Denmark From 1996 to 2020: A Nationwide Study. Diabetes Care 2024:dc232394. [PMID: 38640020 DOI: 10.2337/dc23-2394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/20/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE To examine trends in incidence of acute diabetes complications in individuals with type 1 or type 2 diabetes with and without severe mental illness (SMI) in Denmark by age and calendar year. RESEARCH DESIGN AND METHODS We conducted a cohort study using nationwide registers from 1996 to 2020 to identify individuals with diabetes, ascertain SMI status (namely, schizophrenia, bipolar disorder, or major depression) and identify the outcomes: hospitalization for hypoglycemia and diabetic ketoacidosis (DKA). We used Poisson regression to estimate incidence rates (IRs) and incidence rate ratios (IRRs) of recurrent hypoglycemia and DKA events by SMI, age, and calendar year, accounting for sex, diabetes duration, education, and country of origin. RESULTS Among 433,609 individuals with diabetes, 8% had SMI. Risk of (first and subsequent) hypoglycemia events was higher for individuals with SMI than for those without SMI (for first hypoglycemia event, IRR: type 1 diabetes, 1.77 [95% CI 1.56-2.00]; type 2 diabetes, 1.64 [95% CI 1.55-1.74]). Individuals with schizophrenia were particularly at risk for recurrent hypoglycemia events. The risk of first DKA event was higher in individuals with SMI (for first DKA event, IRR: type 1 diabetes, 1.78 [95% CI 1.50-2.11]; type 2 diabetes, 1.85 [95% CI 1.64-2.09]). Except for DKA in the type 2 diabetes group, IR differences between individuals with and without SMI were highest in younger individuals (<50 years old) but stable across the calendar year. CONCLUSIONS SMI is an important risk factor for acute diabetes complication and effective prevention is needed in this population, especially among the younger population and those with schizophrenia.
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Affiliation(s)
| | | | | | - Lars Diaz
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Vanja Kosjerina
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Copenhagen NV, Denmark
| | - Nanna Lindekilde
- Department of Occupational & Environmental Medicine, Odense University Hospital, Odense, Denmark
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, U.K
| | | | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Michael E Benros
- Copenhagen Research Centre for Biological and Precision Psychiatry, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Center Greenland, Nuuk, Greenland
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark
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Nielsen H, Windolf-Nielsen A, Scheuer SH, Damm P, Nybo Andersen AM, Andersen GS, Nielsen KK. Type 2 diabetes risk after gestational diabetes according to country/region of origin. A nationwide register-based study. J Clin Endocrinol Metab 2024:dgae113. [PMID: 38426346 DOI: 10.1210/clinem/dgae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/04/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
CONTEXT The risk of gestational diabetes mellitus (GDM) differs between the Danish population and several migrant groups. However, it is unclear if the incidence and timing of type 2 diabetes mellitus (T2DM) following GDM vary similarly. OBJECTIVE To investigate the incidence of T2DM according to migration background based on country/region of origin among women with a previous GDM diagnosis and explore the role of time since GDM diagnosis on the association. METHOD Using nationwide registry data, we followed women diagnosed with GDM in Denmark during 2004-2018 to Dec 31, 2020. Poisson regression models were used to estimate incidence rates (IRs) of T2DM according to country/region of origin, adjusted for age, education, and body mass index. RESULTS The study included 20,873 women with a GDM diagnosis, of whom 22.3% were of migrant background and 77.7% were Danish. The mean follow-up time was 7.3 years, and 10.9% were registered with T2DM during the study period. Generally, migrant women had higher IRs of T2DM compared to Danish women, with substantial variations in risk between migrant groups. Women from Pakistan and Sri Lanka had three-four times higher IRs compared to Danish women. The timing of T2DM onset also varied, with women from Sri Lanka and Pakistan having an earlier onset of T2DM compared to other migrant and Danish women. CONCLUSION This study demonstrated that country/region of origin is an important risk factor for T2DM in women with GDM. These findings underscore the importance of prevention programs targeting women with GDM and a high-risk origin.
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Affiliation(s)
- Helene Nielsen
- Clinical Epidemiology Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Anne Windolf-Nielsen
- Clinical Epidemiology Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Stine H Scheuer
- Clinical Epidemiology Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Peter Damm
- Center for Pr---egnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Karoline Kragelund Nielsen
- Department of Prevention, Health Promotion & Community Care, Steno Diabetes Center Copenhagen, Herlev, Denmark
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Lindekilde N, Diaz LJ, Lasgaard M, Henriksen JE, Scheuer SH, Andersen GS, Rubin KH, Pouwer F. Elevated risk of developing type 2 diabetes in people with a psychiatric disorder: What is the role of health behaviors and psychotropic medication? J Diabetes Complications 2023; 37:108591. [PMID: 37820469 DOI: 10.1016/j.jdiacomp.2023.108591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/31/2023] [Accepted: 08/19/2023] [Indexed: 10/13/2023]
Abstract
AIMS Several psychiatric disorders are linked with an increased risk of developing type 2 diabetes (T2D), but the mediating mechanisms are unclear. We aimed to investigate health behaviors, obesity, psychotropic medication use, and comorbidity as potential mediating mechanisms explaining these associations. METHODS We combined data from a large population-based survey with register-based data and followed a sample of 250,013 Danes (≥16 years) for up to 8.9 years. We conducted mediation analyses investigating 10 potential mediators of the associations between psychiatric disorders and incident T2D. RESULTS Individuals with a substance use disorder, schizophrenia, mood disorder, neurotic disorder, eating disorder, or a personality disorder had a significantly higher risk of developing T2D. Organic disorders, intellectual disabilities, developmental and behavioral disorders were not associated with T2D-risk. For all psychiatric disorders significantly associated with T2D, the use of antidepressant medication had the largest proportional mediating effect on the association (13-32 %). CONCLUSIONS Use of antidepressant medication had the largest contribution to the associations between psychiatric disorders and incident T2D. Future epidemiological studies and prevention studies should focus on optimizing the use of antidepressant medication with minimal side effects, and the promotion of health behaviors in individuals with a psychiatric disorder to prevent T2D.
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Affiliation(s)
- Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Occupational and Environmental Medicine, Odense University Hospital, Denmark.
| | - Lars J Diaz
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Mathias Lasgaard
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Jan Erik Henriksen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | | | | | - Katrine H Rubin
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark; Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Denmark
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark; Department of Medical Psychology, Amsterdam UMC, the Netherlands
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4
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Knudsen L, Scheuer SH, Diaz LJ, Jackson CA, Wild SH, Benros ME, Hansen DL, Jørgensen ME, Andersen GS. Indicators of quality of diabetes care in persons with type 2 diabetes with and without severe mental illness: a Danish nationwide register-based cohort study. Lancet Reg Health Eur 2023; 26:100565. [PMID: 36895449 PMCID: PMC9989638 DOI: 10.1016/j.lanepe.2022.100565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND This study aims to examine quality of diabetes care in persons with type 2 diabetes with and without severe mental illness (SMI). METHODS In a nationwide prospective register-based study, we followed persons with type 2 diabetes in Denmark with and without SMI including schizophrenia, bipolar disorder, or major depression. Quality of care was measured as receipt of care (hemoglobin A1c, low-density lipoprotein-cholesterol and urine albumin creatinine ratio assessment and eye and foot screening) and achievement of treatment targets between 2015 and 2019. Quality of care was compared in persons with and without SMI using generalized linear mixed models adjusted for key confounders. FINDINGS We included 216,537 persons with type 2 diabetes. At entry 16,874 (8%) had SMI. SMI was associated with lower odds of receiving care, with the most pronounced difference in urine albumin creatinine ratio assessment and eye screening (OR: 0.55, 95% CI: 0.53-0.58 and OR: 0.37 95% CI: 0.32-0.42, respectively). Among those with an assessment, we found that SMI was associated with higher achievement of recommended hemoglobin A1c levels and lower achievement of recommended low-density lipoprotein-cholesterol levels. Achievement of recommended low-density lipoprotein-cholesterol levels was similar in persons with versus without schizophrenia. INTERPRETATION Compared to persons without SMI, persons with SMI were less likely to receive process of care, with the most pronounced differences in urine albumin creatinine ratio assessment and eye screening. FUNDING This study was funded by Steno Diabetes Center Copenhagen through an unrestricted grant from Novo Nordisk Foundation.
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Affiliation(s)
- Lenette Knudsen
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Stine H. Scheuer
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Lars J. Diaz
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Sarah H. Wild
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael E. Benros
- Biological and Precision Psychiatry, Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte L. Hansen
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Marit E. Jørgensen
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Steno Diabetes Center Greenland, Nuuk, Greenland
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Gregers S. Andersen
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
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5
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Scheuer SH, Fleetwood KJ, Licence KAM, Mercer SW, Smith DJ, Sudlow CLM, Andersen GS, Wild SH, Jackson CA. Severe mental illness and quality of care for type 2 diabetes: A retrospective population-based cohort study. Diabetes Res Clin Pract 2022; 190:110026. [PMID: 35917991 DOI: 10.1016/j.diabres.2022.110026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022]
Abstract
AIMS To compare quality of care for type 2 diabetes in people with severe mental illness (SMI) versus no mental illness. METHODS We used routinely collected linked data to create a retrospective cohort study. We included 158,901 people diagnosed with type 2 diabetes in Scotland during 2009-2018 of whom 1701 (1%), 768 (0.5%) and 5211 (3%) had a prior hospital admission record for schizophrenia, bipolar disorder, and major depression, respectively. We compared recording of HbA1c, cholesterol, creatinine, blood pressure, urinary albumin, foot examination, retinopathy screening, body mass index and smoking during the first year after diabetes diagnosis using logistic regression and recording of HbA1c and retinopathy screening over longer follow-up using generalised linear mixed effects model, adjusting for confounding factors. RESULTS Receipt of care during the first year was generally similar, or better, for people with each SMI than for people without any mental illness. During mean follow up of 4.8 (SD 2.5) years, depression and bipolar disorder were associated with lower odds of receiving retinopathy screening. CONCLUSIONS Receipt of diabetes care was similar or better among people with SMI versus without SMI. However, mechanisms to support improved retinopathy screening for people with SMI are needed.
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Affiliation(s)
| | | | - Kirsty A M Licence
- Information Services Division, National Services Scotland, NHS Scotland, Edinburgh, UK
| | | | - Daniel J Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Cathie L M Sudlow
- Usher Institute, University of Edinburgh, Edinburgh, UK; British Heart Foundation Data Science Centre, UK
| | | | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
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6
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Scheuer SH, Kosjerina V, Lindekilde N, Pouwer F, Carstensen B, Jørgensen ME, Benros ME, Andersen GS. Severe Mental Illness and the Risk of Diabetes Complications: A Nationwide, Register-based Cohort Study. J Clin Endocrinol Metab 2022; 107:e3504-e3514. [PMID: 35359003 DOI: 10.1210/clinem/dgac204] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Individuals with severe mental illness (SMI) are at increased risk of developing type 2 diabetes. OBJECTIVE This work explores whether individuals with diabetes and SMI are also at increased risk of diabetes complications and the potential age-specific differences in development of these. METHODS Using nationwide registry data, we followed the entire Danish population with type 2 diabetes from January 1, 1996 to December 31, 2018. Exposure was SMI (schizophrenia, bipolar, or depression disorders). Outcome was diabetes complications (nephropathy, retinopathy, lower limp amputations, and cardiovascular disease). We applied Poisson regression models to estimate overall incidence rate ratios (IRRs) and age-specific incidence rates (IRs) and IRRs of the first event of each complication in individuals with SMI compared to individuals without SMI. The models were adjusted for sex, age, diabetes duration, calendar year, education, and migration status. RESULTS We followed 371 625 individuals with type 2 diabetes, of whom 30 102 had coexisting diagnosed SMI. Individuals with SMI had a higher IR of nephropathy (IRR: 1.15; 95% CI, 1.12-1.18), amputations (IRR: 1.15; 95% CI, 1.04-1.28), and cardiovascular disease (men: IRR: 1.10; 95% CI, 1.05-1.15, women: IRR: 1.18; 95% CI, 1.13-1.22) but a lower IR of retinopathy (IRR: 0.75; 95% CI, 0.70-0.81) when compared to individuals without SMI, after adjustment for confounders. For all complications except amputations, the difference in IR was highest in the younger age groups. CONCLUSION Individuals with type 2 diabetes and SMI had a higher risk and an earlier onset of several diabetes complications diagnoses, emphasizing focusing on improving diabetes management in younger age groups with SMI.
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Affiliation(s)
| | - Vanja Kosjerina
- Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, 2400 Copenhagen NV, Denmark
| | - Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, 5230 Odense M, Denmark
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, 5230 Odense M, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, 5000 Odense C, Denmark
- School of Psychology, Deakin University, 3220 Geelong, Australia
| | | | - Marit E Jørgensen
- Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen K, Denmark
| | - Michael E Benros
- Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, 2900 Hellerup, Denmark
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
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Lindekilde N, Scheuer SH, Diaz LJ, Rubin KH, Plana-Ripoll O, Henriksen JE, Lasgaard M, Andersen GS, Pouwer F. Risk of Developing Type 2 Diabetes in Individuals With a Psychiatric Disorder: A Nationwide Register-Based Cohort Study. Diabetes Care 2022; 45:724-733. [PMID: 35043146 DOI: 10.2337/dc21-1864] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Previous studies have investigated the incidence of type 2 diabetes in individuals with psychiatric disorders, but most studies have focused on a specific psychiatric disorder or a selected sample. More population-based studies are needed to determine these associations in representative samples. We therefore aimed to determine these associations in a nationwide, register-based dynamic cohort study. RESEARCH DESIGN AND METHODS We analyzed data from 5,005,612 adults living in Denmark between 1995 and 2018, without prior diabetes. We investigated 10 different categories of psychiatric disorders and a composite group with any psychiatric disorder. Individuals with a psychiatric disorder were compared with individuals without using multivariable-adjusted Poisson regression to estimate incidence rate ratios (IRR) of type 2 diabetes. We modeled age-specific incidence rates (IR) for individuals with and without the specific psychiatric disorder. All models were stratified by sex. RESULTS In total, 334,739 individuals developed type 2 diabetes during follow-up. For all investigated categories of psychiatric disorders, we found increased IR of type 2 diabetes for individuals with versus those without a psychiatric disorder (IRR: men, 1.47 [95% CI 1.45-1.50]; women, 1.65 [95% CI 1.62-1.68]). When we examined age-specific IR, the largest differences were found in the younger population (<50 years). CONCLUSIONS We found that the IR of type 2 diabetes was higher in individuals with a psychiatric disorder compared with individuals without a psychiatric disorder and particularly high in the younger people with a psychiatric disorder. New studies into the prevention and early detection of type 2 diabetes in these groups are warranted.
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Affiliation(s)
- Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | - Lars J Diaz
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Katrine H Rubin
- OPEN-Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Jan Erik Henriksen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Mathias Lasgaard
- DEFACTUM-Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | | | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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Lindekilde N, Scheuer SH, Rutters F, Knudsen L, Lasgaard M, Rubin KH, Henriksen JE, Kivimäki M, Andersen GS, Pouwer F. Prevalence of type 2 diabetes in psychiatric disorders: an umbrella review with meta-analysis of 245 observational studies from 32 systematic reviews. Diabetologia 2022; 65:440-456. [PMID: 34841451 DOI: 10.1007/s00125-021-05609-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/01/2021] [Indexed: 01/05/2023]
Abstract
AIMS/HYPOTHESIS Estimates of the global prevalence of type 2 diabetes vary between 6% and 9%. The prevalence of type 2 diabetes has been investigated in psychiatric populations but a critical appraisal of the existing evidence is lacking, and an overview is needed. This umbrella review summarises existing systematic reviews of observational studies investigating the prevalence of type 2 diabetes in people with a psychiatric disorder. METHODS We searched PubMed, EMBASE, PsycINFO and the Cochrane Database of Systematic Reviews from inception to 17 January 2021 and screened reference lists of included systematic reviews. On the basis of prespecified criteria, we included systematic reviews investigating the prevalence of type 2 diabetes in adults (aged ≥18 years) with a psychiatric disorder. Titles and abstracts of 5155 identified records and full texts of 431 selected studies were screened by two independent reviewers, based on predefined eligibility criteria and an a priori developed extraction form, following the PRISMA and MOOSE guidelines. Risk of bias was assessed with the ROBIS instrument. Data extracted from primary studies were synthesised using random-effects meta-analyses. RESULTS A total of 32 systematic reviews with 245 unique primary studies were identified and met inclusion criteria. Twelve had low risk of bias. They reported type 2 diabetes prevalence estimates ranging from 5% to 22% depending on the specific psychiatric disorder. We meta-analysed data for ten categories of psychiatric disorders and found the following prevalence estimates of type 2 diabetes: in people with a sleep disorder: 40%; binge eating disorder: 21%; substance use disorder: 16%; anxiety disorder: 14%; bipolar disorder: 11%; psychosis: 11%; schizophrenia: 10%; a mixed group of psychiatric disorders: 10%; depression: 9%; and in people with an intellectual disability 8%. All meta-analyses revealed high levels of heterogeneity. CONCLUSIONS/INTERPRETATION Type 2 diabetes is a common comorbidity in people with a psychiatric disorder. Future research should investigate whether routine screening for type 2 diabetes and subsequent prevention initiatives for these people are warranted. PROSPERO registration no. CRD42020159870.
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Affiliation(s)
- Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, Odense, Denmark.
| | | | - Femke Rutters
- Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam UMC, location VUMC, Amsterdam, the Netherlands
| | | | - Mathias Lasgaard
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Katrine H Rubin
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jan Erik Henriksen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University of College London, London, UK
| | | | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
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9
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Scheuer SH, Færch K, Philipsen A, Jørgensen ME, Johansen NB, Carstensen B, Witte DR, Andersen I, Lauritzen T, Andersen GS. Response to the Letter: Comment on "Abdominal Fat Distribution and Cardiovascular Risk in Men and Women With Different Levels of Glucose Tolerance" by Scheuer S.H., et al. J Clin Endocrinol Metab 2016; 101:L13-4. [PMID: 26840105 DOI: 10.1210/jc.2015-4297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Stine H Scheuer
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), Gentofte, DK-2820 Copenhagen, Denmark; Danish Diabetes Academy (N.B.J.), DK-5000 Odense, Denmark; Institute of Public Health (D.R.W., T.L.), Section of General Practice, Aarhus University, DK-8000 C Aarhus, Denmark; and Section of Social Medicine (I.A.), Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark
| | - Kristine Færch
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), Gentofte, DK-2820 Copenhagen, Denmark; Danish Diabetes Academy (N.B.J.), DK-5000 Odense, Denmark; Institute of Public Health (D.R.W., T.L.), Section of General Practice, Aarhus University, DK-8000 C Aarhus, Denmark; and Section of Social Medicine (I.A.), Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark
| | - Annelotte Philipsen
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), Gentofte, DK-2820 Copenhagen, Denmark; Danish Diabetes Academy (N.B.J.), DK-5000 Odense, Denmark; Institute of Public Health (D.R.W., T.L.), Section of General Practice, Aarhus University, DK-8000 C Aarhus, Denmark; and Section of Social Medicine (I.A.), Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), Gentofte, DK-2820 Copenhagen, Denmark; Danish Diabetes Academy (N.B.J.), DK-5000 Odense, Denmark; Institute of Public Health (D.R.W., T.L.), Section of General Practice, Aarhus University, DK-8000 C Aarhus, Denmark; and Section of Social Medicine (I.A.), Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark
| | - Nanna B Johansen
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), Gentofte, DK-2820 Copenhagen, Denmark; Danish Diabetes Academy (N.B.J.), DK-5000 Odense, Denmark; Institute of Public Health (D.R.W., T.L.), Section of General Practice, Aarhus University, DK-8000 C Aarhus, Denmark; and Section of Social Medicine (I.A.), Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark
| | - Bendix Carstensen
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), Gentofte, DK-2820 Copenhagen, Denmark; Danish Diabetes Academy (N.B.J.), DK-5000 Odense, Denmark; Institute of Public Health (D.R.W., T.L.), Section of General Practice, Aarhus University, DK-8000 C Aarhus, Denmark; and Section of Social Medicine (I.A.), Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark
| | - Daniel R Witte
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), Gentofte, DK-2820 Copenhagen, Denmark; Danish Diabetes Academy (N.B.J.), DK-5000 Odense, Denmark; Institute of Public Health (D.R.W., T.L.), Section of General Practice, Aarhus University, DK-8000 C Aarhus, Denmark; and Section of Social Medicine (I.A.), Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark
| | - Ingelise Andersen
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), Gentofte, DK-2820 Copenhagen, Denmark; Danish Diabetes Academy (N.B.J.), DK-5000 Odense, Denmark; Institute of Public Health (D.R.W., T.L.), Section of General Practice, Aarhus University, DK-8000 C Aarhus, Denmark; and Section of Social Medicine (I.A.), Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark
| | - Torsten Lauritzen
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), Gentofte, DK-2820 Copenhagen, Denmark; Danish Diabetes Academy (N.B.J.), DK-5000 Odense, Denmark; Institute of Public Health (D.R.W., T.L.), Section of General Practice, Aarhus University, DK-8000 C Aarhus, Denmark; and Section of Social Medicine (I.A.), Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark
| | - Gregers S Andersen
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), Gentofte, DK-2820 Copenhagen, Denmark; Danish Diabetes Academy (N.B.J.), DK-5000 Odense, Denmark; Institute of Public Health (D.R.W., T.L.), Section of General Practice, Aarhus University, DK-8000 C Aarhus, Denmark; and Section of Social Medicine (I.A.), Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark
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Scheuer SH, Færch K, Philipsen A, Jørgensen ME, Johansen NB, Carstensen B, Witte DR, Andersen I, Lauritzen T, Andersen GS. Abdominal Fat Distribution and Cardiovascular Risk in Men and Women With Different Levels of Glucose Tolerance. J Clin Endocrinol Metab 2015; 100:3340-7. [PMID: 26120787 DOI: 10.1210/jc.2014-4479] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT Regional fat distribution rather than overall obesity has been recognized as important to understanding the link between obesity and cardiovascular disease. OBJECTIVE We examined the associations of abdominal visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) with cardiovascular risk factors in a Caucasian population of men and women with normal glucose tolerance, prediabetes, or screen-detected diabetes. DESIGN, SETTING, AND PARTICIPANTS The study was based on cross-sectional analysis of data from 1412 adults age 45-80 years. VAT and SAT were assessed by ultrasound. The associations of VAT and SAT with blood pressure and lipids were examined by linear regression analysis adjusted for age, sex, smoking, alcohol, physical activity, glucose tolerance status (GTS), medication use, and body mass index. Effect modification by GTS and sex was examined, and stratified analyses performed. RESULTS Independent of SAT and overall obesity, VAT was associated with higher triglyceride and lower high-density lipoprotein (HDL) cholesterol levels in both men and women and additionally associated with higher total cholesterol in men. SAT was independently associated with higher total cholesterol and low-density lipoprotein cholesterol levels in both sexes, and SAT was additionally associated with higher triglyceride and lower HDL cholesterol levels in women and with higher blood pressure in participants with diabetes. CONCLUSION Both abdominal VAT and SAT are independent of overall obesity associated with cardiovascular risk in a population of men and women at low to high risk of diabetes or with screen-detected diabetes.
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Affiliation(s)
- Stine H Scheuer
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), 2820 Gentofte, Denmark; Danish Diabetes Academy (N.B.J., D.R.W.), 5000 Odense, Denmark; Institute of Public Health, Section of General Practice (D.R.W., T.L.), Aarhus University, 8000 Aarhus, Denmark; Section of Social Medicine, Department of Public Health (I.A.), University of Copenhagen, 1123 Copenhagen, Denmark
| | - Kristine Færch
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), 2820 Gentofte, Denmark; Danish Diabetes Academy (N.B.J., D.R.W.), 5000 Odense, Denmark; Institute of Public Health, Section of General Practice (D.R.W., T.L.), Aarhus University, 8000 Aarhus, Denmark; Section of Social Medicine, Department of Public Health (I.A.), University of Copenhagen, 1123 Copenhagen, Denmark
| | - Annelotte Philipsen
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), 2820 Gentofte, Denmark; Danish Diabetes Academy (N.B.J., D.R.W.), 5000 Odense, Denmark; Institute of Public Health, Section of General Practice (D.R.W., T.L.), Aarhus University, 8000 Aarhus, Denmark; Section of Social Medicine, Department of Public Health (I.A.), University of Copenhagen, 1123 Copenhagen, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), 2820 Gentofte, Denmark; Danish Diabetes Academy (N.B.J., D.R.W.), 5000 Odense, Denmark; Institute of Public Health, Section of General Practice (D.R.W., T.L.), Aarhus University, 8000 Aarhus, Denmark; Section of Social Medicine, Department of Public Health (I.A.), University of Copenhagen, 1123 Copenhagen, Denmark
| | - Nanna B Johansen
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), 2820 Gentofte, Denmark; Danish Diabetes Academy (N.B.J., D.R.W.), 5000 Odense, Denmark; Institute of Public Health, Section of General Practice (D.R.W., T.L.), Aarhus University, 8000 Aarhus, Denmark; Section of Social Medicine, Department of Public Health (I.A.), University of Copenhagen, 1123 Copenhagen, Denmark
| | - Bendix Carstensen
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), 2820 Gentofte, Denmark; Danish Diabetes Academy (N.B.J., D.R.W.), 5000 Odense, Denmark; Institute of Public Health, Section of General Practice (D.R.W., T.L.), Aarhus University, 8000 Aarhus, Denmark; Section of Social Medicine, Department of Public Health (I.A.), University of Copenhagen, 1123 Copenhagen, Denmark
| | - Daniel R Witte
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), 2820 Gentofte, Denmark; Danish Diabetes Academy (N.B.J., D.R.W.), 5000 Odense, Denmark; Institute of Public Health, Section of General Practice (D.R.W., T.L.), Aarhus University, 8000 Aarhus, Denmark; Section of Social Medicine, Department of Public Health (I.A.), University of Copenhagen, 1123 Copenhagen, Denmark
| | - Ingelise Andersen
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), 2820 Gentofte, Denmark; Danish Diabetes Academy (N.B.J., D.R.W.), 5000 Odense, Denmark; Institute of Public Health, Section of General Practice (D.R.W., T.L.), Aarhus University, 8000 Aarhus, Denmark; Section of Social Medicine, Department of Public Health (I.A.), University of Copenhagen, 1123 Copenhagen, Denmark
| | - Torsten Lauritzen
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), 2820 Gentofte, Denmark; Danish Diabetes Academy (N.B.J., D.R.W.), 5000 Odense, Denmark; Institute of Public Health, Section of General Practice (D.R.W., T.L.), Aarhus University, 8000 Aarhus, Denmark; Section of Social Medicine, Department of Public Health (I.A.), University of Copenhagen, 1123 Copenhagen, Denmark
| | - Gregers S Andersen
- Steno Diabetes Center (S.H.S., K.F., A.P., M.E.J., N.B.J., B.C., G.S.A.), 2820 Gentofte, Denmark; Danish Diabetes Academy (N.B.J., D.R.W.), 5000 Odense, Denmark; Institute of Public Health, Section of General Practice (D.R.W., T.L.), Aarhus University, 8000 Aarhus, Denmark; Section of Social Medicine, Department of Public Health (I.A.), University of Copenhagen, 1123 Copenhagen, Denmark
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