National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark; Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Denmark.
Research Unit for General Practice, Aarhus University, Denmark.
Schizophr Res. 2020 Apr;218:99-106. doi: 10.1016/j.schres.2020.01.024. Epub 2020 Feb 3.
Individuals with schizophrenia often develop diabetes, but little is known about their risk of diabetic complications. We aimed to study incidence of registered diabetic complications and subsequent mortality in individuals with schizophrenia and diabetes compared to individuals with diabetes only.
We conducted a cohort study using nationwide registers and followed all individuals in the entire Danish population diagnosed with diabetes from 1997 to 2017. Incidence rate ratios (IRR) of diabetic complications, all-cause and cause-specific mortality rate ratios (MRR) were estimated by Cox regression comparing individuals diagnosed with schizophrenia and diabetes to individuals diagnosed only with diabetes.
In a cohort of 239,118 individuals with diagnosed diabetes, the incidence of any diabetic complication was similar in females with schizophrenia and diabetes compared to females with diabetes only; IRR = 0.93 (95%CI: 0.84-1.02), and significantly lower in males; IRR = 0.85 (95%CI: 0.78-0.92). The all-cause mortality for individuals with a diagnosis of a diabetic complication was higher in individuals with schizophrenia and diabetes than in those with diabetes only; MRR = 1.92 (95%CI: 1.65-2.23) for females and MRR = 1.69 (95%CI: 1.49-1.92) for males. Among those without diabetic complications, schizophrenia was also associated with a higher mortality.
Individuals with schizophrenia and diabetes had similar or lower rates of diabetic complications, compared to those with diabetes only. Among those with diabetic complications, schizophrenia was associated with higher mortality. Similar, among those without diabetic complications, schizophrenia was also associated with higher mortality. Hence, diabetic complications do not seem to explain the excess mortality seen in individuals with schizophrenia.
精神分裂症患者常发生糖尿病，但对于其发生糖尿病并发症的风险知之甚少。本研究旨在比较精神分裂症合并糖尿病与单纯糖尿病患者的糖尿病并发症发生率和随后死亡率。
我们开展了一项基于全国性登记的队列研究，对 1997 年至 2017 年期间所有被诊断为糖尿病的丹麦人群进行随访。采用 Cox 回归比较精神分裂症合并糖尿病患者和单纯糖尿病患者，以估计糖尿病并发症、全因和特定病因死亡率的发生率比（IRR）。
在一个 239118 例被诊断为糖尿病的队列中，女性精神分裂症合并糖尿病患者的任何糖尿病并发症发生率与单纯糖尿病女性患者相似；IRR=0.93（95%CI：0.84-1.02），而男性患者的发生率显著更低；IRR=0.85（95%CI：0.78-0.92）。在被诊断为糖尿病并发症的患者中，精神分裂症合并糖尿病患者的全因死亡率高于单纯糖尿病患者；女性患者的 MRR=1.92（95%CI：1.65-2.23），男性患者的 MRR=1.69（95%CI：1.49-1.92）。在无糖尿病并发症的患者中，精神分裂症也与更高的死亡率相关。
与单纯糖尿病患者相比，精神分裂症合并糖尿病患者的糖尿病并发症发生率相似或更低。在有糖尿病并发症的患者中，精神分裂症与更高的死亡率相关。同样，在无糖尿病并发症的患者中，精神分裂症也与更高的死亡率相关。因此，糖尿病并发症似乎不能解释精神分裂症患者的过高死亡率。
