Buse John B
Diabetes Care Center, University of North Carolina, Chapel Hill, USA.
J Clin Psychiatry. 2002;63 Suppl 4:37-41.
Approximately 16 million people in the United States have diabetes, and the World Health Organization has estimated that the worldwide prevalence of diabetes will more than double from 1995 to 2025. Type 2 diabetes, the most common form of diabetes, may be 2 to 4 times more prevalent in patients with severe mental disorders. Within the psychiatric community, there is a great deal of concern about diabetes as a potential side effect of antipsychotic agents. An important population to remember in the context of treatment-emergent hyperglycemia is the 20 million people with impaired glucose tolerance (IGT) (fasting plasma glucose > 110 mg/dL and < 126 mg/dL or 2-hour postload glucose > 140 mg/dL and < 200 mg/dL according to the American Diabetes Association). This prediabetic condition has a 5% to 10% annual risk of converting to diabetes. One hypothesis for antipsychotic treatment-emergent diabetes during double-blind, randomized, controlled trials is that people who develop diabetes soon after the initiation of drug therapy for schizophrenia may have had undiagnosed IGT or diabetes before they started treatment. The emergence of diabetes in clinical practice may be due to an observation effect, but because the incidence of diabetes is greater in people with severe mental illnesses, it is crucial for psychiatrists to be aware of national guidelines for the diagnosis and treatment of type 2 diabetes.
美国约有1600万人患有糖尿病，世界卫生组织估计，从1995年到2025年，全球糖尿病患病率将增加一倍多。2型糖尿病是最常见的糖尿病类型，在严重精神障碍患者中的患病率可能高出2至4倍。在精神科领域，糖尿病作为抗精神病药物的潜在副作用备受关注。在治疗引发的高血糖背景下，需要记住的一个重要人群是2000万糖耐量受损（IGT）患者（根据美国糖尿病协会的标准，空腹血糖>110mg/dL且<126mg/dL，或餐后2小时血糖>140mg/dL且<200mg/dL）。这种糖尿病前期状态每年有5%至10%的风险转变为糖尿病。双盲、随机、对照试验中抗精神病药物治疗引发糖尿病的一种假说是，在开始治疗精神分裂症后不久就患上糖尿病的人，在开始治疗前可能患有未被诊断出的IGT或糖尿病。临床实践中糖尿病的出现可能是由于观察效应，但由于严重精神疾病患者中糖尿病的发病率更高，精神科医生了解2型糖尿病的诊断和治疗的国家指南至关重要。
