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High prevalence of prediabetes and metabolic abnormalities in overweight or obese schizophrenia patients treated with clozapine or olanzapine

Published online by Cambridge University Press:  31 December 2018

Julie R. Larsen Open the ORCID record for Julie R. Larsen [Opens in a new window] ,
Camilla K. Svensson ,
Louise Vedtofte ,
Mathilde Lund Jakobsen ,
Hans Søe Jespersen ,
Michelle I. Jakobsen ,
Kamuran Koyuncu ,
Ole Schjerning ,
Jimmi Nielsen  and
Claus T. Ekstrøm
...Show all authors
Julie R. Larsen
Affiliation:
Psychiatric Centre Copenhagen, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Camilla K. Svensson
Affiliation:
Psychiatric Centre Copenhagen, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Louise Vedtofte
Affiliation:
Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
Mathilde Lund Jakobsen
Affiliation:
Psychiatric Centre Copenhagen, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Hans Søe Jespersen
Affiliation:
Psychiatric Centre Copenhagen, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Michelle I. Jakobsen
Affiliation:
Psychiatric Centre Copenhagen, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Kamuran Koyuncu
Affiliation:
Psychiatric Centre Copenhagen, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Ole Schjerning
Affiliation:
Psychiatry, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
Jimmi Nielsen
Affiliation:
Psychiatry, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
Claus T. Ekstrøm
Affiliation:
Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
Jens J. Holst
Affiliation:
NNF Center for Basic Metabolic Research, and Department of Biomedical Sciences, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
Christoph U. Correll
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
Tina Vilsbøll
Affiliation:
Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences; University of Copenhagen, Copenhagen, Denmark Steno Diabetes Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
Anders Fink-Jensen*
Affiliation:
Psychiatric Centre Copenhagen, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences; University of Copenhagen, Copenhagen, Denmark
*
*Address for correspondence: Anders Fink-Jensen, Psychiatric Centre Copenhagen, Rigshospitalet, University of Copenhagen, Edel Sauntes Allé 10, DK-2100 Copenhagen O, Denmark. (Email: anders.fink-jensen@regionh.dk)
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Abstract

Objective

To assess the prevalence of prediabetes and metabolic abnormalities among overweight or obese clozapine- or olanzapine-treated schizophrenia patients, and to identify characteristics of the schizophrenia group with prediabetes.

Methods

A cross-sectional study assessing the presence of prediabetes and metabolic abnormalities in schizophrenia clozapine- or olanzapine-treated patients with a body mass index (BMI) ≥27 kg/m2. Procedures were part of the screening process for a randomized, placebo-controlled trial evaluating liraglutide vs placebo for improving glucose tolerance. For comparison, an age-, sex-, and BMI-matched healthy control group without psychiatric illness and prediabetes was included. Prediabetes was defined as elevated fasting plasma glucose and/or impaired glucose tolerance and/or elevated glycated hemoglobin A1c.

Results

Among 145 schizophrenia patients (age = 42.1 years; males = 59.3%) on clozapine or olanzapine (clozapine/olanzapine/both: 73.8%/24.1%/2.1%), prediabetes was present in 69.7% (101 out of 145). While schizophrenia patients with and without prediabetes did not differ regarding demographic, illness, or antipsychotic treatment variables, metabolic abnormalities (waist circumference: 116.7±13.7 vs 110.1±13.6 cm, P = 0.007; triglycerides: 2.3±1.4 vs 1.6±0.9 mmol/L, P = 0.0004) and metabolic syndrome (76.2% vs 40.9%, P<0.0001) were significantly more pronounced in schizophrenia patients with vs without prediabetes. The age-, sex-, and BMI-matched healthy controls had significantly better glucose tolerance compared to both groups of patients with schizophrenia. The healthy controls also had higher levels of high-density lipoprotein compared to patients with schizophrenia and prediabetes.

Conclusion

Prediabetes and metabolic abnormalities were highly prevalent among the clozapine- and olanzapine-treated patients with schizophrenia, putting these patients at great risk for later type 2 diabetes and cardiovascular disease. These results stress the importance of identifying and adequately treating prediabetes and metabolic abnormalities among clozapine- and olanzapine-treated patients with schizophrenia.

Keywords

Antipsychoticglucose metabolismmetabolic syndromeprediabetesschizophrenia
Type
Original Research
Information
CNS Spectrums , Volume 24 , Issue 4 , August 2019 , pp. 441 - 452
Copyright
© Cambridge University Press 2018 

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Footnotes

We thank Bente Bennike, Signe Foghsgaard, Susie Brøndum, Britt Marie Droob, Lene Bruus Albæk, and Sonja Snel for their assistance in the trial.

The study is an investigator-university initiated study (IIS), which received the liraglutide and the liraglutide placebo pens from Novo Nordisk A/S together with an unrestricted grant. The study received additional funding from the Capital Region Psychiatry Research Group and the foundation of King Christian X.

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