Ouyang Feiyun, He Jun, Cheng Xunjie, Zhou Wei, Xiao Shuiyuan, Fang Junqun
Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.
Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha, China.
Front Psychiatry. 2022 Feb 24;13:754775. doi: 10.3389/fpsyt.2022.754775. eCollection 2022.
Antipsychotics contribute to the development of type 2 diabetes mellitus (T2DM) in individuals with schizophrenia. However, the extent of the relationship between antipsychotic use and T2DM varies in different settings, and the magnitude of the drug-specific effects fluctuates widely. This study aimed to explore the association of T2DM with antipsychotic use among enrollees with schizophrenia in China's National Basic Public Health Service Program (NBPHSP) and the drug-specific relationship with T2DM among patients receiving antipsychotic monotherapy.
We recruited diabetes-free patients with schizophrenia who were enrolled in the NBPHSP of Hunan Province from October 2009 to December 2018. The participants were classified into the following three groups: regular antipsychotic use, intermittent antipsychotic use, and antipsychotic-free groups. The patients were followed up until they received a T2DM diagnosis or until April 2019. Cox regression models were constructed to calculate the overall and drug-specific hazard ratios (HRs) to determine the antipsychotic-T2DM relationship. Interactive and subgroup analyses were performed to assess the heterogeneity of the effects across subgroups.
A total of 122,064 NBPHSP enrollees with schizophrenia were followed up for 1,507,829 cumulative person-years, and 2,313 (1.89%) patients developed T2DM. Patients who regularly and intermittently used antipsychotics had 117% (HR: 2.17, 95% CI: 1.83-2.57) and 53% (HR: 1.53, 95% CI: 1.23-1.90) higher risks of developing T2DM than antipsychotic-free patients, respectively. Regarding monotherapy, the T2DM risk increased by 66, 80, 62, and 64% after the regular use of clozapine, risperidone, chlorpromazine, and perphenazine, respectively. In addition, the antipsychotic-related risk of T2DM decreased as the patient's baseline body mass index, and baseline fasting plasma glucose level, as well as the dietary proportion of animal products, increased.
Antipsychotics, especially clozapine, risperidone, chlorpromazine, and perphenazine, increased the T2DM risk among NBPHSP enrollees with schizophrenia. Mental health officers should accurately identify enrollees at a high risk of T2DM and take appropriate preventive measures to reduce the incidence of T2DM among patients with schizophrenia.
抗精神病药物会促使精神分裂症患者患2型糖尿病（T2DM）。然而，在不同环境中，使用抗精神病药物与T2DM之间的关系程度有所不同，且药物特异性效应的大小波动很大。本研究旨在探讨中国国家基本公共卫生服务项目（NBPHSP）中精神分裂症登记参与者中T2DM与抗精神病药物使用之间的关联，以及接受抗精神病药物单一疗法的患者中T2DM与药物的特异性关系。
我们招募了2009年10月至2018年12月参加湖南省NBPHSP的无糖尿病精神分裂症患者。参与者被分为以下三组：规律使用抗精神病药物组、间歇性使用抗精神病药物组和未使用抗精神病药物组。对患者进行随访，直至他们被诊断为T2DM或直至2019年4月。构建Cox回归模型以计算总体和药物特异性风险比（HRs），以确定抗精神病药物与T2DM的关系。进行交互分析和亚组分析以评估各亚组效应的异质性。
总共对122,064名参加NBPHSP的精神分裂症患者进行了1,507,829人年的累计随访，2313名（1.89%）患者患T2DM。规律和间歇性使用抗精神病药物的患者患T2DM的风险分别比未使用抗精神病药物的患者高117%（HR：2.17，95%CI：1.83 - 2.57）和53%（HR：1.53，95%CI：1.23 - 1.90）。关于单一疗法，规律使用氯氮平、利培酮、氯丙嗪和奋乃静后，T2DM风险分别增加66%、80%、62%和64%。此外，随着患者的基线体重指数、基线空腹血糖水平以及动物产品饮食比例的增加，抗精神病药物相关的T2DM风险降低。
抗精神病药物，尤其是氯氮平、利培酮、氯丙嗪和奋乃静，增加了参加NBPHSP的精神分裂症患者患T2DM的风险。心理健康工作人员应准确识别T2DM高风险的登记参与者，并采取适当的预防措施以降低精神分裂症患者中T2DM的发病率。
