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March 2004 Issue

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More Study Needed on Weight, Diabetes Risk for Mentally Ill Patients

Published March 2004

More research is needed to evaluate various factors affecting patients treated for mental illness before concluding that some treatments increase diabetes risk, said Paul E. Keck, Jr., MD, professor of psychiatry, pharmacology and neuroscience, and vice chairman for research, Department of Psychiatry, UC College of Medicine.

In an article published in a December 2003 Special Report to Postgraduate Medicine “Metabolic Disease and Severe Mental Illness,” Dr. Keck says more clinical data is needed to determine which factors may influence the increased incidence of diabetes among those treated for mental illness, which is nearly four times greater than the general population. He says further investigation is needed to clarify whether chronic mental illness itself is a risk factor for type 2 diabetes and obesity; whether psychotic illnesses have an impact on glucose regulation; how co-morbid psychiatric conditions — such as binge eating, alcohol abuse and nicotine dependence — interact with psychotic and mood disorders to affect weight and diabetes risk, and whether some second-generation anti-psychotics affect metabolic risk factors associated with diabetes.

“Although some second-generation anti-psychotics are associated with weight gain, more clinical data is needed to determine whether these agents have direct effects on insulin secretion, insulin sensitivity and lipid metabolism distinct from those effects produced by weight gain alone,” explained Dr. Keck. “It is still unclear how some second-generation anti-psychotics affect some individuals’ susceptibility to weight gain and whether these medications adversely influence glucose and lipid metabolism.”

While waiting for clarification of these controversial issues, Dr. Keck recommends comprehensive clinical monitoring. Specific recommendations to physicians include:

  • Educate patients about good nutrition and managing weight with diet and exercise, and establish weight management as a therapeutic goal from the start of treatment.
  • Monitor body weight/body mass index and advise the patient about decreasing caloric consumption and increasing physical activity if patients are at risk for obesity.
  • Screen patients frequently for diabetes, regardless of age, when they are overweight and have one or more risk factors for type 2 diabetes. Patients who gain weight rapidly after the start of treatment should also be frequently screened for diabetes
  • Consider screening patients with mental illness at diagnosis and every one to three years, regardless of age and other risk factors because of the risk for type 2 diabetes posed by psychotic and mood disorders themselves.
  • Screen for lipid abnormalities in older patients and in younger patients with coronary heart disease risk factors.
  • Refer patients with hyperglycemia or elevated lipids for treatment with appropriate hypoglycemic and lipid-lowering agents.

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