Department of Social and Behavioural Medicine, Pavol Jozef Safarik University Faculty of Medicine, Kosice, Slovakia.
Center for Mental Functions, Vranov nad Toplou, Slovakia.
Front Endocrinol (Lausanne). 2024 Feb 14;15:1354749. doi: 10.3389/fendo.2024.1354749. eCollection 2024.
Type 1 diabetes mellitus is characterized by an absolute insulin deficiency requiring the lifetime intensive insulin therapy accompanied by daily self-monitoring, self-management, ongoing education, and complex diabetes care. Regular patient-clinician shared therapeutic decisions based on age, sex, comorbidities, medications, predicted impact of meals, physical activity, stress, hormonal changes, insulin therapy, and patterns of glycemic changes are key for achieving glycemic targets. The impact of various phases of bipolar disorder and their treatment on continuous glucose levels remains unexplored and calls for future assessments.
The present case reports a 41-year-old Caucasian female with an established diagnosis of bipolar II disorder and type 1 diabetes mellitus who discontinued long-term mood-stabilizing pharmacotherapy with quetiapine. Real-time continuous glucose monitoring performed before and 6-months following the discontinuation of quetiapine revealed hidden glucose patterns in medicated versus unmedicated bipolar disorder. Despite the known adverse metabolic effects of quetiapine, the continuous glucose monitoring captured more stable and near-normal continuous glucose values during the antipsychotic treatment compared to unmedicated stages of bipolar disorder with considerably higher glucose values and glucose variability.
The case report highlights the importance of the ongoing psychopharmacotherapy of bipolar disorder in comorbid type 1 diabetes mellitus to reduce mood-induced reactivity, emotional urgency, and non-emotional impulsivity that may contribute to dysglycemia. If not effectively treated, the "bipolar diabetes" is likely to progress to multiple psychiatric and somatic complications. The bidirectional links between the phases of bipolar disorder and the corresponding continuous glucose patterns can help advance clinical decision-making and yield innovative1 research that can translate into efficacious clinical practice.
1 型糖尿病的特征是绝对胰岛素缺乏，需要终身强化胰岛素治疗，并伴有日常自我监测、自我管理、持续教育和复杂的糖尿病护理。基于年龄、性别、合并症、药物、预计对膳食、体力活动、压力、激素变化、胰岛素治疗和血糖变化模式的影响，定期进行医患共同治疗决策对于实现血糖目标至关重要。双相情感障碍各阶段及其治疗对连续血糖水平的影响仍未得到探索，需要进一步评估。
本病例报告了一位 41 岁的白人女性，患有确诊的双相情感障碍 II 型和 1 型糖尿病，她停止了长期的稳定情绪药物治疗，即喹硫平。在停止使用喹硫平之前和之后的 6 个月进行实时连续血糖监测，揭示了在用药和未用药的双相情感障碍中隐藏的血糖模式。尽管喹硫平具有已知的代谢不良影响，但与未用药的双相情感障碍阶段相比，连续血糖监测在抗精神病治疗期间捕捉到更稳定和接近正常的连续血糖值，血糖值和血糖变异性都更高。
该病例报告强调了在合并 1 型糖尿病的双相情感障碍中持续进行精神药理学治疗的重要性，以降低情绪诱发的反应性、情感紧迫性和非情感冲动，这可能导致血糖异常。如果不能有效治疗，“双相糖尿病”很可能发展为多种精神和躯体并发症。双相情感障碍各阶段与相应连续血糖模式之间的双向联系有助于推进临床决策，并产生可转化为有效临床实践的创新 1 研究。
