Review ArticleThe prevalence of diabetes mellitus and abnormal glucose metabolism in the inpatient psychiatric setting: A systematic review and meta-analysis
Introduction
The prevalence of diabetes mellitus (DM) and abnormal glucose metabolism is often reported as higher in psychiatric inpatients compared to the general population, [1] and as a co-morbidity has been associated with an increased length of stay [2]. Psychiatric patients with abnormal glucose metabolism have poorer long-term outcomes including increased tendency to relapse of mental illness, [3], [4] and increased mortality secondary to an increased risk of cardiovascular disease [5]. Appropriate detection and treatment of abnormal glucose metabolism is thus an important target for interventions to improve clinical outcomes in psychiatric inpatients. Reported prevalence estimates for DM in psychiatric inpatients range from 2% to 25% and are often based on small cross-sectional studies, [6], [7] which frequently are limited to subpopulations, including those with particular diagnoses or on particular psychotropic medication [8].
Previous systematic reviews in patients with psychiatric illness have focused on the prevalence of metabolic syndrome, or of exclusively type two diabetes mellitus (T2DM) [9], [10], [11], [12], [13]. Whilst rates of 30–40% [9], [14] of metabolic syndrome, and 7–13% of T2DM [12], [13] are commonly reported they offer no specific detail on prevalence of T1DM or impaired glucose metabolism, and do not focus on the psychiatric inpatient setting. The burden of disease of DM, impaired fasting glucose (IFG), and impaired glucose tolerance (IGT) within the inpatient setting remains uncertain despite these disease states having specific and alternative interventions available as management strategies, with the inpatient setting representing an excellent window of opportunity for both screening and intervention. Improved knowledge and screening for abnormal glucose metabolism has the potential to improve and personalise inpatient psychotropic prescribing regimens leading to fewer diabetogenic prescriptions in those with states of impaired glucose metabolism but without frank diabetes.
As yet no systematic review has provided pooled prevalence estimates of all types of DM, IFG or IGT in psychiatric inpatients despite an increase in the awareness of the need for physical health screening and management of chronic medical conditions in patients with psychiatric illness [15]. With greater emphasis being placed on improving diagnosis and management of co-morbid medical conditions within psychiatric inpatient settings, this study aims to systematically review the literature and fill this gap. We aimed to present a pooled prevalence of DM, IFG and IGT in psychiatric inpatients and to explore the impact of study populations and characteristics on prevalence estimates.
Section snippets
Data sources
We searched Embase, Medline, PsychINFO and the Cochrane Central Register of Controlled Trials, from database inception to December 1st 2015 for studies published in English. Three authors (AB, TD and LJ) initially assessed the titles and abstracts identified by the search and reviewed the full text of the remaining articles for inclusion. Any discrepancy was resolved by discussion, and where agreement could not be reached a fourth author (ER) was consulted. All relevant references were checked
Results
The search identified 1114 abstracts. 100 full texts were examined and 36 study reports comprising 42 unique cohorts were included in the analysis. An included studies flow diagram and list of excluded studies can be found in the online supplementary material as eFigure three and eTable one respectively. Thirty one study cohorts reported the prevalence of DM of unspecified type, five reported prevalence of T1DM, thirteen of T2DM, seven of IFG and three of IGT. Across all studies prevalence of
Discussion
Across all studies one in ten psychiatric inpatients has a diagnosis of diabetes mellitus, one in five has a diagnosis of impaired fasting glucose and one in five has a diagnosis of impaired glucose tolerance. The prevalence of T2DM is consistent with other reviews in patients with serious mental illness (SMI), but to our knowledge we are the first group to report a pooled prevalence of impaired glucose metabolism in psychiatric inpatients. All estimates are higher compared to the general
Disclosures/conflicts of interest
All authors have completed the ICJME declarations of interest form.
Dr. R's time on the project was supported by a National Institute of Health Research (NIHR) academic clinical fellowship.
Dr. J has nothing to disclose.
Dr. B has nothing to disclose.
Dr. D has nothing to disclose.
Ms. M has nothing to disclose.
Dr. K currently receives salary support from Novo Nordisk UK Research Foundation and was funded by National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health
Role of the funding source
The study received no funding or sponsorship from any source.
Acknowledgments
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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