The risk of diabetes and HbA1c deterioration during antipsychotic drug treatment: A Danish two-cohort study among patients with first-episode schizophrenia.

IF 5.3 2区医学 Q1 PSYCHIATRY Acta Psychiatrica Scandinavica Pub Date : 2024-10-08 DOI:10.1111/acps.13760

Nanna M Madsen, Marc A Sørensen, Andreas A Danielsen, Mikkel Højlund, Christopher Rohde, Ole Köhler-Forsberg

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Abstract

Background: Antipsychotics increase the risk of developing diabetes, but clinical trials are not generalizable with short follow-up, while observational studies often lack important information, particularly hemoglobin A1c (HbA1c).

Methods: We followed two Danish cohorts with schizophrenia. First, using Danish nationwide registers, we identified all individuals diagnosed with first-episode schizophrenia (FES) between 1999 and 2019 (n = 31,856). Exposure was a redeemed prescription for an antipsychotic, and the outcome was diabetes, defined via hospital-based diagnosis and redeemed prescriptions for glucose-lowering drugs. Adjusted Cox regression calculated hazard rate ratios (HRR). Second, using data from the Central Denmark Region, we identified all individuals diagnosed with FES from October 2016 to September 2022 (n = 2671). Using a within-subject design, we analyzed the change in HbA1c during the 2 years after initiation of specific antipsychotics compared to the 2 years before.

Results: In the nationwide cohort, 2543 (8.0%) individuals developed diabetes (incidence rate = 9.39 [95% CI = 9.03-9.76] per 1000 person-years). Antipsychotics, compared to periods without, were associated with an increased risk of developing diabetes (HRR = 2.04, 95% CI = 1.75-2.38). We found a dose-response association, particularly for second-generation antipsychotics, and different risk rates for specific antipsychotics. In the Central Denmark Region cohort, a total of 9.2% developed diabetes but mean HbA1c levels remained stable at 37 mmol/mol during the 2 years after initiation of antipsychotic medication.

Conclusion: This comprehensive real-world two-cohort study emphasizes that diabetes affects almost 10% of patients with FES. Antipsychotics increase this risk, while HbA1c deterioration requires longer treatment. These findings are important for clinicians and young patients with FES.

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抗精神病药物治疗期间糖尿病和 HbA1c 恶化的风险：一项针对首发精神分裂症患者的丹麦双队列研究。

背景：抗精神病药物会增加罹患糖尿病的风险，但临床试验的随访时间较短，不具有普遍性，而观察性研究往往缺乏重要信息，尤其是血红蛋白 A1c (HbA1c)：我们对两组丹麦精神分裂症患者进行了跟踪研究。首先，我们利用丹麦全国范围的登记册，确定了1999年至2019年期间所有被诊断为首发精神分裂症（FES）的患者（n = 31,856）。暴露是指兑换的抗精神病药物处方，结果是指通过医院诊断和兑换的降糖药处方定义的糖尿病。调整后的 Cox 回归计算出了危险率比 (HRR)。其次，利用丹麦中部大区的数据，我们确定了2016年10月至2022年9月期间诊断为FES的所有患者（n = 2671）。采用受试者内设计，我们分析了开始使用特定抗精神病药物后两年内与之前两年相比 HbA1c 的变化：在全国范围内的队列中，有 2543 人（8.0%）罹患糖尿病（发病率=每千人年 9.39 [95% CI = 9.03-9.76]）。与未服用抗精神病药物的时期相比，服用抗精神病药物会增加患糖尿病的风险（HRR = 2.04，95% CI = 1.75-2.38）。我们发现了剂量反应关系，尤其是第二代抗精神病药物，而且特定抗精神病药物的风险率也不同。在丹麦中部地区队列中，共有9.2%的患者罹患糖尿病，但在开始服用抗精神病药物后的两年内，平均HbA1c水平稳定在37 mmol/mol：这项全面的真实世界双队列研究强调，近10%的FES患者患有糖尿病。抗精神病药物会增加这种风险，而 HbA1c 恶化则需要更长时间的治疗。这些发现对临床医生和年轻的 FES 患者非常重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.