NEW YORK (Reuters Health) – Based on the 2010 American Diabetes Association’s definition of prediabetes, the condition is present in over a third of psychiatric inpatients treated with antipsychotic drugs, according to a report in the Journal of Clinical Psychiatry online December 27.
“The excess in body mass index and abdominal distribution of adiposity found by us confirms the primary role of central obesity in the pathogenesis of insulin resistance in this population,” the authors comment.
Dr. Peter Manu, with the Zucker Hillside Hospital in Glen Oaks, New York, and colleagues note that the ADA has proposed classifying prediabetes as a fasting glucose levels of 100-125 mg/dL or a glucose level of 140-199 mg/dL at 2 hours after an oral 75-g glucose tolerance test or a hemoglobin A1c concentration of 5.7%-6.4%.
Identification of prediabetes offers a chance to prevent the development of overt diabetes, a condition that afflicts many patients treated with second-generation antipsychotics, they continue.
To determine the prevalence of prediabetes in this population, the team studied 783 adult psychiatric inpatients hospitalized at the University Psychiatric Center of the Catholic University Leuven in Belgium. The mean age was 37.6 years and almost all were treated with second-generation antipsychotics.
While 52.8% of this cohort had normal glucose tolerance, 37.0% were prediabetic and 10.2% had previously undiagnosed diabetes mellitus, the investigators found.
The prevalence of obesity (BMI at least 30) was 25.2% in the prediabetic group compared with 13.6% in the group 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 to prevent the emergence of diabetes mellitus, but Dr. Manu and colleagues found only 6.6% of prediabetic patients in their study met these criteria. They therefore suggest that the criteria may need to be revised, at least for this patient population.
Summing up, they say, “The finding that more than 1 of 3 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.”
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