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High prevalence of pre-diabetes and diabetes in psychiatric inpatients (#348)

Pratyusha Naidu 1 , Alvin Kong , Henry Wong , Arielle Van Mourik , Anthony Yao , Elizabeth Cornish , Graeme K Hart , Elizabeth Owen-Jones , Raymond Robbins , Que Lam , Jeffrey Zajac , Elif I Ekinci
  1. Department of Endocrinology, Austin Health, Level 2 Centaur Building Repatriation Campus , Heidelberg West , VIC 3081, Australia

RATIONALE: Although the development of pre-diabetes and diabetes in psychiatric patients has been attributed to atypical anti-psychotic drugs, the role of other factors has been less studied.

AIM: To determine the prevalence and characteristics of psychiatry inpatients with pre-diabetes and diabetes.

METHODS: Inpatients at the Austin psychiatry unit (February-2014 to April-2015) above the age of 30 had measurements of HbA1c as part of routine clinical care as part of the Diabetes Discovery Initiative. Based on the HbA1c measurements, patients were divided into three groups – pre-diabetes (HbA1c 5.7-6.4%), diabetes (HbA1c >6.5%) and no diabetes (HbA1c < 5.6%).  Baseline characteristics including demographics, co-morbidities, duration of psychiatric illness and treatments were collected.

RESULTS: A total of 335 psychiatry inpatients had HbA1c measurements, out of which 14%(n=46) had diabetes, 19%(n=63) had pre-diabetes and 67%(n=226) had no diabetes. The most prevalent diagnoses were schizophrenia, depression and substance abuse. More than 50% of inpatients were either treated with atypical antipsychotics (50% in diabetics versus 54% in non-diabetics, p=0.9) or anti-depressants (65% in diabetics versus 52% in non-diabetics, p=0.1). Compared to non-diabetics, patients with diabetes were predominantly older (median±IQR) age 49 (39,62) versus age 40(34,48), p=<0.001), unemployed (89% versus 73%, p=0.02), were at least twice as likely to have hypertension, obesity and hyperlipidaemia (all, p≤0.002) and trended towards being male (70% versus 54%, p=0.106) and had high rates of substance abuse (37% versus 22.6%, p=0.050). A similar trend was observed in the pre-diabetes group compared to non-diabetes group. Patients with diabetes and pre-diabetes trended towards a longer duration of psychiatric illness and both had a longer inpatient stay. 

CONCLUSIONS: Psychiatric patients have a high risk for developing pre-diabetes and diabetes, which is associated with older age, high number of physical co-morbidities, high unemployment rate, substance abuse, and increased length of hospital stay. Therefore, the management and follow up of these patients is complex.

  1. People living with Psychotic Illness 2010, Australian Government, 2011
  2. Diabetes and psychiatric disorders, Yatan Pal Singh Balhara Indian J Endocrinol Metab. 2011 Oct-Dec; 15(4): 274-283
  3. DIABETES, PSYCHOTIC DISORDERS AND ANTIPSYCHOTIC THERAPY- A consensus statement, Assoc Prof Tim Lambert and Dr Leon Chapman , 2004
  4. The High Prevalence of Poor Physical Health and Unhealthy Lifestyle Behaviours in Individuals with Severe Mental Illness , 2011