NEW YORK (Reuters Health) Jan 17 – More than a third of psychiatric inpatients on antipsychotic drugs meet American Diabetes Association criteria for prediabetes, according to a recent publication.
Patients generally had ”(an) excess in body mass index and abdominal distribution of adiposity,” which ”confirms the primary role of central obesity in the pathogenesis of insulin resistance in this population,” the authors reported online December 27 in the Journal of Clinical Psychiatry.
Dr. Peter Manu, with the Zucker Hillside Hospital in Glen Oaks, New York, and colleagues studied 783 adults, with an average age of 38, who were hospitalized at the University Psychiatric Center of the Catholic University Leuven in Belgium. Almost all were being treated with second-generation antipsychotics.
While 52.8% had normal glucose tolerance, 10.2% had undiagnosed diabetes mellitus and 37.0% were prediabetic, based on the ADA’s proposed criteria for prediabetes (i.e., fasting glucose of 100-125 mg/dL, or 140-199 mg/dL at two hours after an oral 75-g glucose tolerance test, or hemoglobin A1c of 5.7%-6.4%).
The prevalence of obesity (BMI at least 30) was 25.2% in the prediabetic patients, compared with 13.6% in patients with normal glucose tolerance, the report indicates. Mean waist circumference was significantly higher in the participants with prediabetes (97.2 cm in men, 93.7 cm for women) than in the normoglycemic patients (94.4 cm men, 88.5 cm women).
The authors note that the ADA has formulated guidelines for treating prediabetes with metformin, but Dr. Manu and colleagues found only 6.6% of prediabetic patients in their study met these criteria. They suggest that the criteria may need to be revised, at least for this patient population.
Summing up, they say, ”The finding that more than one of three antipsychotic-treated mentally ill adults in this study had prediabetes is clearly alarming.”
They add, ”These results should further stimulate concerted efforts toward widespread cardiometabolic monitoring, which has remained inadequate, as well as toward more aggressively preserving or restoring glucose tolerance, insulin sensitivity, and overall metabolic health.”
J Clin Psychiatry 2011.
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