Authors (including presenting author) :
Ho MTH(1)(2), Chan JKN(2), Chiu WCY(1), Tsang LLW(1), Chan KSW(1), Wong MMC(1), Wong HH(1), Pang PF(1), Chang WC(2)(3). Risk of mortality and complications in patients with severe mental illness and co-occurring diabetes mellitus: a systematic review and meta-analysis.
Affiliation :
(1)Department of Psychiatry, United Christian Hospital, Hong Kong SAR, (2)Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, (3)State Key Laboratory of Brain & Cognitive Sciences, University of Hong Kong, Hong Kong SAR
Introduction :
People with severe-mental-illness (SMI), often defined as “schizophrenia-spectrum disorders and bipolar disorder”, have increased premature mortality and elevated prevalence of diabetes compared with general population. Evidence indicated that one-third of their premature death was from cardiovascular diseases (CVD), with risk conferred by diabetes. Although earlier studies have examined SMI-associated diabetes-related outcomes, findings were inconsistent and not systematically evaluated.
Objectives :
We aimed to comprehensively evaluate the major diabetes-related outcomes in patients with SMI and co-occurring diabetes, in order to explore the potential links that underlie cardiovascular diseases and mortality gap in SMI. We also aimed to provide an evidence synthesis to inform healthcare policy and treatment recommendations in the diabetes care of people with SMI.
Methodology :
We systematically reviewed and quantitatively synthesized diabetes-related outcomes in patients with SMI (schizophrenia-spectrum disorders and bipolar disorder) by searching Embase, MEDLINE, PsycInfo, and Web-of-Science from inception to 31-March-2024, and included studies examining mortality and complication outcomes in SMI patients with co-occurring diabetes relative to patients with diabetes-only. Results were synthesized by random-effects models, with stratified-analyses by study-level characteristics. The study was registered with PROSPERO (CRD42023448490).
Result & Outcome :
Twenty-one studies involving 161,156 SMI patients with co-occurring diabetes were identified from ten regions. Regarding mortality risk, SMI-diabetes group exhibited increased risks of all-cause mortality (RR=1.77[95% CI: 1.46–2.14]) and CVD-specific mortality (1.88[1.73–2.04]) relative to diabetes-only group. All-cause mortality risk was present in distinct regions and has persisted over time. Regarding complication risk, SMI-diabetes group showed higher risk of any complications (1.23[1.06–1.43]) than comparison, with stratified-analyses showing higher risk of metabolic-complications (1.84[1.58–2.15]), and lower likelihood of peripheral-vascular complications (0.91[0.84–0.99]), neuropathy (0.85[0.78–0.93]), and retinopathy (0.70[0.60–0.82]), albeit comparable cardiovascular-complications (1.04[0.89–1.22]), cerebrovascular-complications (1.07[0.86–1.33]), and nephropathy (0.92[0.72–1.17]). High heterogeneity was noted and could not be fully-explained by subgroup-analyses. Implementation of targeted interventions is needed to rectify their diabetes-related outcomes and mortality gap.
