Prevalence of Diabetes and Prediabetes in People with Severe Mental Illness

Research suggests racial/ethnic background can also play a role in increased risk of diagnosis.

A systematic review and meta-analysis found that people with severe mental illness (SMI) had an increased risk of diabetes, an effect possibly due to the frequent use of antipsychotic medications, which have been found to raise fasting glucose and cause weight gain. Furthermore, some psychiatric conditions, like schizophrenia, are associated with poor diet, weight gain, and sedentary lifestyle owing to an increased risk of diabetes. Looking beyond these potential risk factors, some evidence has shown that racial and ethnic minorities with SMI are at an even higher risk for diabetes. By learning what predisposes patients to diabetes, this information can hopefully reduce the prevalence.

Using data from Kaiser Permanente Northern California (KPNC), the study sought to first estimate prevalence of diabetes and prediabetes in patients with SMI as well as establish if a link exists between diabetes and racial/ethnic background. In order to determine diabetes prevalence, patients were included if they were in the KPNC diabetes registry prior to December 2014. In addition, determination of prediabetes prevalence was done by excluding those with diabetes and including those with appropriate fasting blood glucose (100-125 mg/dL) and HbA1c (5.7-6.4%). Prevalence rates for diabetes and prediabetes and racial/ethnic background details can be found in Table 1: Diabetes/Prediabetes Prevalence and Racial/Ethnic Background.

Table 1: Diabetes/Prediabetes Prevalence and Racial/Ethnic Background
Diabetes Prevalence	Complete Sample: 17.3% (4399/25422) Screened: 28.1% (4399/15629)
Prediabetes Prevalence	Complete Sample: 33.0% (6815/20658) Screened: 46.9% (6815/14536)
Racial/Ethnic Background (with diabetes)	Higher prevalence in Hispanics (p = 0.018) and blacks (p = 0.037) by 20 years of age. Higher prevalence in Asian (p = 0.031) by 30 years of age.	Black 36.3% Asian Pacific Islander 30.7% Hispanic 36.9% White 25.1% (p < 0.001)
Racial/Ethnic Background (with prediabetes)	Higher prevalence in racial/ethnic minorities by 20 years of age*	Asian (p = 0.032)* Black (p = 0.0003)* Hispanic (p = 0.013)*
*Prediabetes racial/ethnic minority prevalence at 20 years old, p-values

Overall, the retrospective study showed that prevalence of diabetes and prediabetes was higher in racial/ethnic minorities especially if they have SMI, (severe mental illness) compared to whites. The higher rates were noted in patients age 20 years old. Furthermore, the last bit of information gleaned from this study was that patients with SMI who smoked showed higher rates of diabetes and prediabetes. Investigators hope these results can optimize diabetes prevention strategies by targeting those with severe mental illness who are at a particularly high risk for diabetes and prediabetes.

Practice Pearls:

• Rates of diabetes and prediabetes are higher in patients with severe mental illness.
• In general, racial/ethnic minorities (i.e. Hispanic, black, Asian) are at a higher risk for diabetes and prediabetes.
• Patients diagnosed with severe mental illness who smoke show higher rates of diabetes/prediabetes.

References:

Christina V. Mangurian, Dean Schillinger, John W. Newcomer, Eric Vittinghoff, Susan M. Essock, Zheng Zhu, Wendy T. Dyer and Julie A. Schmittdiel. Diabetes and Prediabetes Prevalence by Race and Ethnicity Among People With Severe Mental Illness. Diabetes Care 2018 May; dc180425. https://doi.org/10.2337/dc18-0425.

Llorente, M. and Urrutia, V. Diabetes, Psychiatric Disorders, and the Metabolic Effects of Antipsychotic Medications. Clinical Diabetes. 24.1 (2006): 18-24. https://doi.org/10.2337/diaclin.24.1.18.

Kaytie A. Weierstahl, Pharm.D. Candidate, LECOM School of Pharmacy