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Combination therapy as a potential risk factor for the development of type 2 diabetes in patients with schizophrenia:
Vasiliki Mamakou1,2, Sophie Hackinger3, Eleni Zengini4,5
1Medical School, National and Kapodistrian University Athens, 75 M. Assias Street, 115 27, Athens, Greece. vmamakou@hotmail.com.
Background:
Schizophrenia (SCZ) is associated with increased risk of type 2 diabetes (T2D). The potential diabetogenic effect of concomitant application of psychotropic treatment classes in patients with SCZ has not yet been evaluated. The overarching goal of the Genetic Overlap between Metabolic and Psychiatric disease (GOMAP) study is to assess the effect of pharmacological, anthropometric, lifestyle and clinical measurements, helping elucidate the mechanisms underlying the aetiology of T2D.
Methods:
The GOMAP case-control study (Genetic Overlap between Metabolic and Psychiatric disease) includes hospitalized patients with SCZ, some of whom have T2D. We enrolled 1653 patients with SCZ; 611 with T2D and 1042 patients without T2D. This is the first study of SCZ and T2D comorbidity at this scale in the Greek population. We retrieved detailed information on first- and second-generation antipsychotics (FGA, SGA), antidepressants and mood stabilizers, applied as monotherapy, 2-drug combination, or as 3- or more drug combination. We assessed the effects of psychotropic medication, body mass index, duration of schizophrenia, number of hospitalizations and physical activity on risk of T2D. Using logistic regression, we calculated crude and adjusted odds ratios (OR) to identify associations between demographic factors and the psychiatric medications.
Results:
Patients with SCZ on a combination of at least three different classes of psychiatric drugs had a higher risk of T2D [OR 1.81 (95% CI 1.22-2.69); p = 0.003] compared to FGA alone therapy, after adjustment for age, BMI, sex, duration of SCZ and number of hospitalizations. We did not find evidence for an association of SGA use or the combination of drugs belonging to two different classes of psychiatric medications with increased risk of T2D [1.27 (0.84-1.93), p = 0.259 and 0.98 (0.71-1.35), p = 0.885, respectively] compared to FGA use.
Conclusions:
We find an increased risk of T2D in patients with SCZ who take a combination of at least three different psychotropic medication classes compared to patients whose medication consists only of one or two classes of drugs.
Insights
Patients with schizophrenia (SCZ) taking three or more psychotropic medication classes face a higher risk of type 2 diabetes (T2D). This contrasts with those on one or two medication classes, highlighting medication complexity
Area of Science:
- Psychiatry
- Endocrinology
- Pharmacology
Background:
- Schizophrenia (SCZ) is linked to an increased risk of type 2 diabetes (T2D).
- The diabetogenic effects of combined psychotropic medications in SCZ patients were previously unevaluated.
- The Genetic Overlap between Metabolic and Psychiatric disease (GOMAP) study investigates the interplay between metabolic and psychiatric disorders.
Purpose of the Study:
- To assess the impact of psychotropic medication combinations on T2D risk in SCZ patients.
- To elucidate mechanisms underlying T2D etiology in the context of SCZ.
- To analyze pharmacological, anthropometric, and clinical factors associated with T2D in SCZ.
Main Methods:
- A case-control study involving 1653 SCZ patients (611 with T2D, 1042 without T2D) in Greece.
- Detailed data collection on first- and second-generation antipsychotics (FGA, SGA), antidepressants, and mood stabilizers (monotherapy, 2-drug, or 3+ drug combinations).
- Logistic regression analysis to calculate odds ratios (OR) for T2D risk, adjusted for BMI, duration of SCZ, hospitalizations, and physical activity.
Main Results:
- Patients on at least three psychotropic drug classes had a significantly higher T2D risk (OR 1.81; p=0.003) compared to FGA monotherapy.
- No significant T2D risk increase was observed for SGA use (OR 1.27; p=0.259) or 2-drug combinations (OR 0.98; p=0.885) versus FGA monotherapy.
- The findings were adjusted for age, BMI, sex, SCZ duration, and hospitalization frequency.
Conclusions:
- A combination of three or more psychotropic medication classes increases T2D risk in SCZ patients.
- Medication complexity, rather than specific drug classes like SGA, appears to be a key factor.
- This research underscores the importance of medication management in mitigating T2D risk within the SCZ population.
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