Predictors of type 2 diabetes in a nationally representative sample of adults with psychosis

Foley, Debra L., MacKinnon, Andrew, Morgan, Vera A., Watts, Gerald F., McGrath, John J., Castle, David J., Waterreus, Anna and Galletly, Cherrie A. (2014) Predictors of type 2 diabetes in a nationally representative sample of adults with psychosis. World Psychiatry, 13 2: 176-183. doi:10.1002/wps.20130


Author Foley, Debra L.
MacKinnon, Andrew
Morgan, Vera A.
Watts, Gerald F.
McGrath, John J.
Castle, David J.
Waterreus, Anna
Galletly, Cherrie A.
Title Predictors of type 2 diabetes in a nationally representative sample of adults with psychosis
Journal name World Psychiatry   Check publisher's open access policy
ISSN 2051-5545
1723-8617
Publication date 2014-06
Year available 2014
Sub-type Article (original research)
DOI 10.1002/wps.20130
Open Access Status
Volume 13
Issue 2
Start page 176
End page 183
Total pages 8
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Collection year 2015
Language eng
Abstract Antipsychotic drugs such as clozapine and olanzapine are associated with an increased risk for type 2 diabetes, but relatively little is known about the relationship between risk factors for type 2 diabetes established in the general population and type 2 diabetes in people with psychosis. We estimated the prevalence of established risk factors and their association with type 2 diabetes in a nationally representative sample of people with an ICD-10 psychosis (N=1642) who gave a fasting blood sample (N=1155). Logistic regression was used to summarize associations adjusted for age and sex. In this sample, whose mean duration of psychosis was 14.7 years, 12.1% (13.1% of women and 11.5% of men) had type 2 diabetes at age 18-64 years based on current fasting blood glucose levels or treatment with a hypoglycaemic drug. Risk was greatly increased in young adults compared with the general population and peaked in middle age. Risk factors in the general population were common in people with psychosis and strongly associated with type 2 diabetes in those people. Treatment with clozapine was associated with an increased risk and treatment with olanzapine with a decreased risk for type 2 diabetes. The development of diabetes or pre-diabetes may therefore influence the likelihood of treatment with olanzapine over time. The strongest predictors of type 2 diabetes in a multivariate model were a body mass index of at least 40 and treated hypercholesterolemia, followed by a body mass index between 35 and 39.9, a family history of diabetes and treated hypertension. There was minimal to no confounding of the association between type 2 diabetes and current clozapine or olanzapine treatment, but neither association remained significant after adjustment for other predictors. Longitudinal relationships among predictors are likely to be complex, and previous antipsychotic drug treatment may at least partly explain risks associated with severe obesity, dyslipidemia and hypertension. A focus on weight loss is warranted in people with psychosis, but prevention strategies for type 2 diabetes should be broadened to include those with emerging dyslipidemia, hypertension and a family history of diabetes.
Keyword Type 2 diabetes
Psychosis
Risk factors
Clozapine
Olanzapine
Body mass index
Hypercholesterolemia
Hypertension
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Queensland Brain Institute Publications
Official 2015 Collection
 
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