Screening for Diabetes and Other Metabolic Abnormalities in Patients With Schizophrenia and Schizoaffective Disorder: Evaluation of Incidence and Screening Methods. [CME]
J Clin Psychiatry 2006;67(10):1493-1500
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To assess the diagnostic
properties of 2 different screening guidelines for the
detection of diabetes in patients diagnosed with
Method: Over a 2-year period
(November 2003-November 2005), 415 patients with
schizophrenia were screened with a full laboratory screening and a 75-g oral glucose tolerance
test (OGTT). The sensitivity of 2 screening
strategies was compared with the "gold standard":
the OGTT. The 2 strategies were (1) assessing
fasting glucose in all patients, as suggested by the
American Psychiatric Association/American Diabetes Association (APA/ADA), and (2) a
screening strategy derived from the guidelines of the
World Health Organization of assessing fasting
glucose in all patients (step 1) and subsequently
performing an OGTT in patients with impaired
fasting glucose (step 2).
Results: Of the total sample, 6.3% (N =
26) met criteria for diabetes, resulting in a mean
annual incidence of diabetes of 3.15% (6.3% incident cases/2 years). A screening based on
the APA/ADA guidelines detected diabetes in 12 (46.2%) of the 26 cases identified by the
OGTT. The proposed 2-step strategy detected 25
(96.2%) of 26 cases.
Conclusion: The data suggest a high
incidence of diabetes in patients diagnosed with schizophrenia. However, the guidelines to
detect diabetes as proposed by the APA/ADA did not sufficiently detect diabetes in this specific
high-risk group. The alternative 2-step strategy
was able to detect the vast majority of diabetes
cases and should therefore be considered in the
clinical routine of screening and monitoring patients