Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.
Centre de Recherche INSERM Unité 866, Université de Bourgogne-Franche-Comté, Dijon, France
Diabetes Care. 2018 Nov;41(11):2316-2321. doi: 10.2337/dc18-0657. Epub 2018 Aug 27.
The aim of this large retrospective cohort study was to estimate the supplementary morbidity and mortality risks conferred by the co-occurrence of schizophrenia among young people with type 1 diabetes.
This nationwide population-based study included individuals aged 15-35 years hospitalized in France for type 1 diabetes from 2009 to 2012 with or without schizophrenia. For assessment of the occurrence of rehospitalization for acute diabetes complications, suicide attempts, and hospital mortality, multivariate logistic regressions and survival analysis adjusted for age, sex, and Charlson comorbidity index scores were performed. The association between hospitalization for suicide attempts and acute diabetes complications was further explored in a survival analysis, with the exposure of acute diabetes complications as a time-dependent covariate.
Among 45,655 individuals aged 15-35 years who were hospitalized for type 1 diabetes, 341 (0.75%) had a previous or contemporary hospitalization for schizophrenia. Within 3 years of follow-up, schizophrenia was associated with increased risks of rehospitalization for hypoglycemia (adjusted odds ratio 3.21 [95% CI 1.99-5.20]), hyperglycemia (7.01 [3.53-13.90]), ketoacidosis (2.01 [1.49-2.70]), and coma (3.17 [1.90-5.27]); hospitalization for suicide attempts (12.15 [8.49-17.38]); and hospital mortality (2.83 [1.50-5.36]). Hospitalization for a suicide attempt was associated with an increased risk of hospitalization for acute diabetes complications independently from schizophrenia (hazard ratio 3.46 [95% CI 2.74-4.38]).
Patients suffering from the combination of type 1 diabetes and schizophrenia are at increased risk of hospitalization for acute diabetes complications as well as suicide and hospital mortality. These individuals may require specific care programs and close monitoring of mental, somatic, and social health.
本大规模回顾性队列研究旨在评估年轻人在患有 1 型糖尿病的同时患有精神分裂症时所带来的额外发病率和死亡率风险。
本项全国性基于人群的研究纳入了 2009 年至 2012 年期间在法国因 1 型糖尿病住院的年龄在 15-35 岁之间的个体，这些个体中有的患有精神分裂症，有的没有。为了评估因急性糖尿病并发症、自杀未遂和医院死亡率而再次住院的情况，我们进行了多变量逻辑回归和生存分析，并对年龄、性别和 Charlson 合并症指数评分进行了调整。在生存分析中，我们进一步探讨了因自杀未遂和急性糖尿病并发症而住院之间的关联，将急性糖尿病并发症作为一个时依协变量。
在 45655 名年龄在 15-35 岁之间因 1 型糖尿病住院的个体中，有 341 名（0.75%）在过去或同时期因精神分裂症住院。在 3 年的随访期间，精神分裂症与因低血糖症（校正比值比 3.21 [95%CI 1.99-5.20]）、高血糖症（7.01 [3.53-13.90]）、酮症酸中毒（2.01 [1.49-2.70]）和昏迷（3.17 [1.90-5.27]）而再次住院的风险增加有关；因自杀未遂而住院（12.15 [8.49-17.38]）；以及医院死亡率（2.83 [1.50-5.36]）。因自杀未遂而住院与因急性糖尿病并发症而住院的风险增加独立相关，风险比为 3.46 [95%CI 2.74-4.38]。
患有 1 型糖尿病和精神分裂症的患者因急性糖尿病并发症以及自杀和医院死亡率而住院的风险增加。这些个体可能需要特定的护理计划和对精神、躯体和社会健康的密切监测。
