Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England.
Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England2MRC London Institute of Medical Sciences, Hammersmith Hospital, London, England3Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, England.
JAMA Psychiatry. 2017 Mar 1;74(3):261-269. doi: 10.1001/jamapsychiatry.2016.3803.
Schizophrenia is associated with an increased risk of type 2 diabetes. However, it is not clear whether schizophrenia confers an inherent risk for glucose dysregulation in the absence of the effects of chronic illness and long-term treatment.
To conduct a meta-analysis examining whether individuals with first-episode schizophrenia already exhibit alterations in glucose homeostasis compared with controls.
The EMBASE, MEDLINE, and PsycINFO databases were systematically searched for studies examining measures of glucose homeostasis in antipsychotic-naive individuals with first-episode schizophrenia compared with individuals serving as controls.
Case-control studies reporting on fasting plasma glucose levels, plasma glucose levels after an oral glucose tolerance test, fasting plasma insulin levels, insulin resistance, and hemoglobin A1c (HbA1c) levels in first-episode antipsychotic-naive individuals with first-episode schizophrenia compared with healthy individuals serving as controls. Two independent investigators selected the studies.
Two independent investigators extracted study-level data for a random-effects meta-analysis. Standardized mean differences in fasting plasma glucose levels, plasma glucose levels after an oral glucose tolerance test, fasting plasma insulin levels, insulin resistance, and HbA1c levels were calculated. Sensitivity analyses examining the effect of body mass index, diet and exercise, race/ethnicity, and minimal (≤2 weeks) antipsychotic exposure were performed.
Of 3660 citations retrieved, 16 case-control studies comprising 15 samples met inclusion criteria. The overall sample included 731 patients and 614 controls. Fasting plasma glucose levels (Hedges g = 0.20; 95% CI, 0.02 to 0.38; P = .03), plasma glucose levels after an oral glucose tolerance test (Hedges g = 0.61; 95% CI, 0.16 to 1.05; P = .007), fasting plasma insulin levels (Hedges g = 0.41; 95% CI, 0.09 to 0.72; P = .01), and insulin resistance (homeostatic model assessment of insulin resistance) (Hedges g = 0.35; 95% CI, 0.14 to 0.55; P = .001) were all significantly elevated in patients compared with controls. However, HbA1c levels (Hedges g = -0.08; CI, -0.34 to 0.18; P = .55) were not altered in patients compared with controls.
These findings show that glucose homeostasis is altered from illness onset in schizophrenia, indicating that patients are at increased risk of diabetes as a result. This finding has implications for the monitoring and treatment choice for patients with schizophrenia.
精神分裂症与 2 型糖尿病风险增加有关。然而，在没有慢性疾病和长期治疗影响的情况下，精神分裂症是否会导致葡萄糖调节紊乱，目前尚不清楚。
进行荟萃分析，以检查首发精神分裂症患者的葡萄糖稳态是否与对照组相比已经发生改变。
系统地检索了 EMBASE、MEDLINE 和 PsycINFO 数据库，以寻找比较抗精神病药物初治首发精神分裂症患者和作为对照的个体的葡萄糖稳态测量的研究。
病例对照研究报告了空腹血浆葡萄糖水平、口服葡萄糖耐量试验后血浆葡萄糖水平、空腹血浆胰岛素水平、胰岛素抵抗和血红蛋白 A1c（HbA1c）水平在与健康个体作为对照的首发抗精神病药物初治首发精神分裂症患者中的情况。两名独立的调查员选择了这些研究。
两名独立的调查员提取了用于随机效应荟萃分析的研究水平数据。计算了空腹血浆葡萄糖水平、口服葡萄糖耐量试验后血浆葡萄糖水平、空腹血浆胰岛素水平、胰岛素抵抗和 HbA1c 水平的标准化均数差值。还进行了敏感性分析，以检查体重指数、饮食和运动、种族/民族以及最小（≤2 周）抗精神病药物暴露的影响。
从 3660 篇引文检索中，有 16 项病例对照研究共 15 个样本符合纳入标准。总体样本包括 731 名患者和 614 名对照。空腹血浆葡萄糖水平（Hedges g=0.20；95%置信区间，0.02 至 0.38；P=0.03）、口服葡萄糖耐量试验后血浆葡萄糖水平（Hedges g=0.61；95%置信区间，0.16 至 1.05；P=0.007）、空腹血浆胰岛素水平（Hedges g=0.41；95%置信区间，0.09 至 0.72；P=0.01）和胰岛素抵抗（稳态模型评估的胰岛素抵抗）（Hedges g=0.35；95%置信区间，0.14 至 0.55；P=0.001）在患者中均显著高于对照组。然而，与对照组相比，HbA1c 水平（Hedges g=-0.08；CI，-0.34 至 0.18；P=0.55）在患者中并未改变。
这些发现表明，精神分裂症从发病开始就存在葡萄糖稳态紊乱，表明患者患糖尿病的风险增加。这一发现对精神分裂症患者的监测和治疗选择具有重要意义。
