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Patients on Antipsychotics Need Screening for Diabetes

Testing fasting blood glucose and measuring abdominal obesity is a cost-effective approach to identifying patients taking second-generation antipsychotics with metabolic syndrome. While individual components of the syndrome such as dyslipidemia and hyperglycemia are known to be associated with the drugs, Dr. David Straker of Columbia University Medical Center and colleagues write, its prevalence in these patients is not clear. Also, the researchers note, patients taking second-generation antipsychotics are not routinely screened for the syndrome.
Not only does the metabolic syndrome make mortality and morbidity from cardiovascular causes more likely, the researchers add, but schizophrenia itself has been tied to a higher risk of cardiovascular disease.

To investigate the prevalence of the syndrome among patients taking the drugs and identify a cost-effective means of identifying them, the researchers looked at 89 near-consecutive acutely admitted psychiatric patients taking at least one second-generation antipsychotic. Twenty-six, or 29.2%, met criteria for the syndrome, with older age and higher body mass index (BMI) being risk factors.

The researchers found no relationship between psychiatric diagnosis and metabolic syndrome risk, and no particular medications were associated with the syndrome.

Combining waist circumference over 40 inches in men and 35 inches in women and fasting blood glucose at or above 110mg/dL identified all 26 patients with the metabolic syndrome, the researchers found, while combining waist circumference with elevated blood pressure (130/85 mg/Hg or above) identified 25, or 96.2%.

While the design and size of the study does not make it possible to determine whether particular medications or diagnoses are related to the metabolic syndrome, Dr. Straker and colleagues note, the study is the largest to date to investigate the relationship between antipsychotic treatment and the syndrome’s various components.

Combining waist measurement and fasting blood glucose is a "simple and inexpensive" method for identifying metabolic syndrome in these patients, they conclude, while blood pressure and waist measurement can be used in outpatient settings where fasting blood work is less practical.
Am J Psychiatry 2005;162;1217-1221


SEARCH has been a 5-year multi-center study of diabetes in youth funded by the CDC and NIDDK. The numbers will surprise some folks. Incidence (#262) is 20.2 of type 1 and 1.3 of type 2 per 100,000 population per year in youth aged 0-19 years, plus some untypeable and some previously unrealized numbers of hybrid disease to reach a total of 26.3 – and they have ethnicity breakdowns. Prevalence (#1012) is 1.6 of type 1 and 0.4 of type 2 per 1,000 population aged 0-19 years, again with some untypeable and hybrid to reach 1.82. Note (#1906) that about one-third of those diagnosed as type 2 by clinicians were found to have type 1 by SEARCH in antibody and other testing not typically done in clinical practice. This is not surprising when one notices (#1875) that about one-third of those found to have type I were also overweight or obese, which might lead the clinician to suspect type 2. ADA 65th Scientific Sessions Poster #262,1012,1906 & 1875.