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The association between first-episode psychosis and abnormal glycaemic control : systematic review and meta-analysis
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Perry, Benjamin Ian, McIntosh, Gemma, Weich, Scott, Singh, Swaran P. and Rees, Karen (2016) The association between first-episode psychosis and abnormal glycaemic control : systematic review and meta-analysis. The Lancet Psychiatry, 3 (11). pp. 1049-1058. doi:10.1016/S2215-0366(16)30262-0 ISSN 2215-0366.
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WRAP-association-episode-abnormal-review-Perry-2016.pdf - Accepted Version - Requires a PDF viewer. Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0. Download (1022Kb) | Preview |
Official URL: http://dx.doi.org/10.1016/S2215-0366(16)30262-0
Abstract
Background
Schizophrenia might share intrinsic inflammatory disease pathways with type 2 diabetes. We aimed to assess whether first-episode psychosis, which could be described as developing schizophrenia, is associated with prediabetic markers, or developing diabetes, to determine whether intrinsic disease links could cause the disorders to develop in unison. We hypothesised that biochemical measures of prediabetic states would be more common in antipsychotic naive patients with first-episode psychosis than in healthy matched controls.
Methods
For this systematic review and meta-analysis, using PRISMA criteria, we searched Embase, MEDLINE, PsycINFO, Web of Science, and Google Scholar for clinical studies published between database inception and Jan 6, 2016. We assessed case-control studies with biochemical assessment of prediabetic states in patients with first-episode psychosis alongside matched controls. We sought data at the summary estimate level. Several measurements were used to test for prediabetes, including fasting plasma glucose, insulin resistance (measured by the Homeostatic Model Assessment), and impaired glucose tolerance. We calculated standardised mean differences for each outcome. We used the inverse variance method, for which the weight given to each study was the inverse of the variance of the effect estimate. For dichotomous outcomes, we entered the number of events and number in each group into RevMan 5.3 and used the Mantel-Haenszel method to pool studies.
Findings
We identified 1436 studies, of which 12 were included in final analysis, including 1137 participants. Pooled analyses found first-episode psychosis to be related to insulin resistance (mean difference 0·30 [95% CI 0·18 to 0·42]), impaired glucose tolerance (mean difference 1·31 [0·37 to 2·25]), and the number of patients with impaired glucose tolerance (odds ratio 5·44 [2·63 to 11·27]), but not fasting plasma glucose (mean difference 0·03 mmol/L [–0·04 to 0·09]).
Interpretation
Our findings suggest a potential link between prediabetic markers, in particular impaired glucose tolerance and insulin resistance, and first-episode psychosis. However, we cannot establish causality, and the studies contributing to this review were at some risk of bias. Nevertheless, the findings might help to explain the increased prevalence of type 2 diabetes in patients with schizophrenia and could have implications for the management of patients with schizophrenia.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RC Internal medicine R Medicine > RM Therapeutics. Pharmacology |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Schizophrenia, Non-insulin-dependent diabetes, Antipsychotic drugs, Systematic reviews (Medical research) | ||||||||
| Journal or Publication Title: | The Lancet Psychiatry | ||||||||
| Publisher: | Elsevier Ltd. | ||||||||
| ISSN: | 2215-0366 | ||||||||
| Official Date: | November 2016 | ||||||||
| Dates: |
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| Volume: | 3 | ||||||||
| Number: | 11 | ||||||||
| Page Range: | pp. 1049-1058 | ||||||||
| DOI: | 10.1016/S2215-0366(16)30262-0 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access | ||||||||
| Date of first compliant deposit: | 15 June 2017 | ||||||||
| Date of first compliant Open Access: | 15 June 2017 |
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