FRIDAY, Jan. 30, 2004 (HealthDayNews) -- More research is needed to determine which factors may influence the increased incidence of diabetes -- nearly four times greater than the general population -- among people being treated for mental illness, says a University of Cincinnati report.
Further investigation is necessary to clarify whether chronic mental illness itself is a risk factor for type 2 diabetes and obesity; whether some second-generation antipsychotic drugs affect metabolic risk factors associated with diabetes; whether mental illness has an impact on glucose regulation; and how co-morbid psychiatric conditions -- such as alcohol abuse, binge eating and nicotine dependence -- interact with psychotic and mood disorders to affect weight and diabetes risk.
"Although some second-generation antipsychotics are associated with weight gain, more clinical data are 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," Dr. Paul E. Keck, Jr., a professor of psychiatry, pharmacology and neuroscience at the University of Cincinnati College of Medicine, says in prepared statement.
"It is still unclear how some second-generation antipsychotics affect some individuals' susceptibility to weight gain and whether these medications adversely influence glucose and lipid metabolism directly," Keck says.
Until these issues are settled, physicians need to closely monitor patients being treated for psychotic and mood disorders, the report advises.
It recommends that doctors:
- 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 and 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 at the start of treatment should also be frequently screened for diabetes.
- Consider screening patients with mental illness when they're diagnosed 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.
The report, sponsored by a grant from drug manufacturer Eli Lilly and Co., appeared in a recent issue of Postgraduate Medicine.
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