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Screening for Diabetes and Other Metabolic Abnormalities in Patients With Schizophrenia and Schizoaffective Disorder: Evaluation of Incidence and Screening Methods

Ruud van Winkel, M.D.; Marc De Hert, M.D., Ph.D.; Dominique Van Eyck, M.D.; Linda Hanssens, M.S., M.S.P.H.; Martien Wampers, Ph.D.; Andre Scheen, M.D., Ph.D.; and Joseph Peuskens, M.D., Ph.D.

Objective: To assess the diagnostic properties of 2 different screening guidelines for the detection of diabetes in patients diagnosed with schizophrenia.

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 with schizophrenia.

(J Clin Psychiatry 2006;67:1493-1500)

Received March 29, 2006; accepted May 16, 2006. From the University Psychiatric Center, Katholieke Universiteit Leuven, Kortenberg (Drs. van Winkel, De Hert, Van Eyck, Wampers, and Peuskens); and the Department of Epidemiology and Public Health (Ms. Hanssens) and the Department of Diabetes, Nutrition and Metabolic Disorders, CHU Sart Tilman (Dr. Scheen), University Liege, Liege, Belgium.

This study was made possible by an unrestricted, non-conditional educational grant by Global Epidemiology and Outcomes Research (GEOR), Bristol-Myers Squibb.

Financial disclosure is listed at the end of the article.

Corresponding author and reprints: Marc De Hert, M.D., Leuvense Steenweg 517, 3070 Kortenberg, Belgium (e-mail: