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Query: UMLS:C0011860 (type 2 diabetes)
 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Atypical antipsychotics (AAP) have been widely used for the management of patients with schizophrenia and other psychotic disorders since they were introduced during the past decade. AAP, as a class, have demonstrated a significant advantage over conventional antipsychotics in clinical efficacy and lower incidence of extrapyramidal symptoms (EPS) and tardive dyskinesia (TD). However, there have been numerous case reports, retrospective studies, epidemiological and clinical data suggesting that certain AAP may be associated with a greater risk of metabolic abnormalities than others, including weight gain, hyperlipidemia, and new-onset type 2 diabetes mellitus (DM) or diabetic ketoacidosis (DKA). In this article, we review and evaluate recent findings addressing the issue of glucose dysregulation associated with AAP therapy along with the recommendations with a recent consensus conference on this issue. Rational patient monitoring guidelines are also elucidated, particularly for high-risk populations that need more intensive scrutiny during treatment of AAP.
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PMID:Atypical antipsychotics and glucose dysregulation: a systematic review. 1547 92

Drs. Alam and Janicak briefly review the current indications and problems associated with the use of atypical antipsychotics in schizophrenia treatment. When called for, they may be augmented by mood stabilizers, such as lithium; antidepressants; benzodiazepines (for rapid tranquillization during agitated psychotic episodes); and stimulants, even nicotine, to improve cognition. Even though extrapyramidal side effects are less frequent and less intense that those seen with traditional antipsychotics, they do occur; the authors spell out the attributes of those patients who are most vulnerable. Clinicians should also look for weight gain and the risk of activating or aggravating type 2 diabetes in patients, as well as cardiac risk involving prolongation of the QTc interval. Because, despite of modern approaches to treatment, 80% of patients end up rehospitalized and only 1 in 3 can be said to have a good level of socialization, active measures must be taken to ensure continuity of care, monitoring for prodromal symptoms, early intervention, and psychosocial rehabilitation.
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PMID:The role of psychopharmacotherapy in improving the long-term outcome of schizophrenia. 1586 20

Type 2 diabetes mellitus and obesity have reached epidemic proportions in many developing and developed nations, leading to talk of the "twin epidemics." The latest projections from the International Diabetes Federation suggest that 190 million people worldwide currently have type 2 diabetes. In addition, > or = 300 million people worldwide have impaired glucose tolerance (IGT). These statistics represent an epidemic of major proportions--possibly the largest epidemic in human history--in terms of glucose intolerance and cardiovascular disease (CVD) risk because individuals with IGT are at substantially higher risk for diabetes and CVD than are members of the general population. Along with IGT, the metabolic syndrome comprises other major CVD risk factors, including insulin resistance, central obesity, and dyslipidemia; insulin resistance has been implicated as the single most common cause of the syndrome. Although the exact prevalence of the metabolic syndrome is unknown, the syndrome is widespread among adults in developed nations, becoming more prevalent with age. Epidemiologic data suggest that in patients with schizophrenia or affective disorders, both diabetes and obesity are 1.5 to 2.0 times more prevalent than in the general population. Furthermore, because adverse effects of certain therapies for human immunodeficiency virus (HIV) infection and psychiatric disorders increase the risk for developing diabetes, obesity, and the metabolic syndrome, such therapies should be carefully chosen, particularly considering CVD risk. Appropriate therapy may be determined via screening of patients for levels of fasting blood glucose and lipids, as well as other CVD risk factors, before initiating use of second-generation antipsychotic agents or highly active antiretroviral therapy.
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PMID:Epidemiology of diabetes mellitus and associated cardiovascular risk factors: focus on human immunodeficiency virus and psychiatric disorders. 1590 89

In the United States, the risk of type 2 diabetes is currently growing to epidemic proportions, with many physicians unaware that disorders such as schizophrenia and bipolar disorder naturally place patients at an increased risk for diabetes. Another serious concern for physicians is the development of metabolic syndrome, also known as syndrome X, in patients suffering from schizophrenia. Metabolic syndrome often encompasses medical conditions such as weight gain, hypertriglyceridemia, and increased insulin, glucose, and low-density lipoprotein cholesterol levels. Treatment with atypical antipsychotics may increase the risk of metabolic syndrome and diabetes, and physicians need to be proactive when treating patients with schizophrenia. Physicians should be aware that the treatment of schizophrenia involves the right balance for the patient in terms of adverse effects versus benefit, and failing to treat a patient's mental illness because of potential medical problems may place the patient at an increased risk for more serious problems.
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PMID:Metabolic changes associated with antipsychotic use. 1600 Oct 95

Much of the worlds' population is in active or imminent danger from established infectious pathogens, while sporadic and pandemic infections by these and emerging agents threaten everyone. RNA polymerases (RNApol) generate enormous genetic and consequent antigenic heterogeneity permitting both viruses and cellular pathogens to evade host defences. Thus, RNApol causes more morbidity and premature mortality than any other molecule. The extraordinary genetic heterogeneity defining viral quasispecies results from RNApol infidelity causing rapid cumulative genomic RNA mutation a process that, if uncontrolled, would cause catastrophic loss of sequence integrity and inexorable quasispecies extinction. Selective replication and replicative homeostasis, an epicyclical regulatory mechanism dynamically linking RNApol fidelity and processivity with quasispecies phenotypic diversity, modulating polymerase fidelity and, hence, controlling quasispecies behaviour, prevents this happening and also mediates immune escape. Perhaps more importantly, ineluctable generation of broad phenotypic diversity after viral RNA is translated to protein quasispecies suggests a mechanism of disease that specifically targets, and functionally disrupts, the host cell surface molecules--including hormone, lipid, cell signalling or neurotransmitter receptors--that viruses co-opt for cell entry. This mechanism--"Viral Receptor Disease (VRD)"--may explain so-called "viral autoimmunity", some classical autoimmune disorders and other diseases, including type II diabetes mellitus, and some forms of obesity. Viral receptor disease is a unifying hypothesis that may also explain some diseases with well-established, but multi-factorial and apparently unrelated aetiologies--like coronary artery and other vascular diseases--in addition to diseases like schizophrenia that are poorly understood and lack plausible, coherent, pathogenic explanations.
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PMID:Replicative homeostasis II: influence of polymerase fidelity on RNA virus quasispecies biology: implications for immune recognition, viral autoimmunity and other "virus receptor" diseases. 1611 20

Type 2 diabetes is an important medical condition associated with serious mental illness. The authors studied the disease-specific knowledge about diabetes in a sample of 201 psychiatric outpatients with a diagnosis of schizophrenia or major mood disorders, all of whom had type 2 diabetes. In a multivariate analysis, disease-specific diabetes knowledge was associated with higher cognitive functioning, a higher level of education, and recent receipt of diabetes education. Disease-specific diabetes knowledge predicted lower levels of perceived barriers to diabetes care. Gaps in diabetes knowledge may be reduced by specialized interventions that take into account the cognitive deficits of persons with serious mental illness.
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PMID:Diabetes knowledge among persons with serious mental illness and type 2 diabetes. 1614 86

People with schizophrenia are more likely to develop type 2 diabetes than the general population. Although an increased risk of diabetes has been attributed to environmental determinants such as diet, lifestyle and antipsychotic drugs, the association between these two disorders was noticed well before the advent of current lifestyles and pharmacological interventions, raising the possibility of a shared genetic basis. Schizophrenia and type 2 diabetes are common diseases with a complex mode of inheritance which includes both genetic factors and environmental determinants. As susceptibility genes for both type 2 diabetes and schizophrenia are beginning to be identified there is increasing interest in the possibility of shared susceptibility loci between the two conditions. This article reviews the genetic basis to schizophrenia and type 2 diabetes and discusses the potential for shared loci between both conditions.
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PMID:Clustering of metabolic comorbidity in schizophrenia: a genetic contribution? 1628 Mar 37

First-generation antipsychotic drugs, efficacious in reducing the "positive" syndrome of schizophrenia, carried serious motor side effects, such as immobility and Parkinsonism. While second-generation antipsychotics have reduced the incidence of such effects, they are not without risk. It has come to light that both first- and second-generation antipsychotics are associated with weight gain and type 2 diabetes. This short review addresses this issue, as well as covers recent studies to find which neurotransmitter receptors may be involved in the induction of these metabolic disturbances.
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PMID:Study focuses in on potential cause of antipsychotic-induced diabetes. 1639 16

The relatively high comorbidity of type 2 diabetes and schizophrenia may suggest a shared biological susceptibility to these two conditions. Family studies have demonstrated an increased risk of diabetes in unaffected relatives of patients with schizophrenia, consistent with a heritable susceptibility trait. Linkage analyses have identified several loci that are associated with schizophrenia and some of these, notably those on chromosomes 2p22.1-p13.2 and 6g21-824.1 have also been observed in linkage studies in type 2 diabetes. In addition, the dopamine D5 receptor on chromosome 5 and the tyrosine hydroxylase gene on chromosome 11 have both been suggested as candidate genes in schizophrenia and may also be implicated in susceptibility to poor glycaemic control. In addition, an increased rate of type II diabetes has been observed in some patients treated with antipsychotics. Potential neurochemical substrates of this effect include the histamine H1 receptor, the 5-HT2C serotonin receptor or the beta3 adrenoreceptor. However, the search for a genetic basis to the association between diabetes and schizophrenia is still in its infancy, and much further work needs to be performed, including the systematic screening of all confirmed susceptibility loci and quantitative trait locus mapping of glycaemic control.
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PMID:Schizophrenia, antipsychotics and diabetes: Genetic aspects. 1645 47

Obesity and diabetes have caused problems for individuals with schizophrenia long before atypical antipsychotic agents. The prevalence of obesity, insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, dyslipidemia, and the Metabolic Syndrome has increased in people with schizophrenia as compared to the general population. Risk reduction studies for persons with obesity, diabetes, and cardiovascular disease indicate that cognitive/behavioral interventions that promote motivation and provide strategies to overcome the barriers in adherence to diet and activity modification are effective interventions for weight management and risk reduction. In the landmark multi-center randomized-controlled trial study, the Diabetes Prevention Project (DPP), a cognitive/behavioral intervention, was more successful in producing weight loss and preventing diabetes than the drugs metformin, troglitazone or placebo. This pilot study examined the effectiveness of a cognitive/behavioral group intervention, modified after the DPP program, in individuals with schizophrenia or schizoaffective disorder taking atypical antipsychotics in a large urban public mental health system. Outcome measures included body weight, body mass index, waist-hip ratios, and fasting glucose levels. Both groups demonstrated elevated fasting glucose levels and were obese with a mean BMI of 33. The group that received the cognitive/behavioral group intervention lost more weight than the treatment as usual group. The CB group participants lost an average of 5.4 lb or 2.9% of body weight, and those in the control group lost 1.3 lb or 0.6% body weight. The range of weight loss for the treatment group was from 1 to 20 lb. This pilot study has demonstrated that weight loss is possible with cognitive/behavioral interventions in a population with a psychotic disorder.
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PMID:A cognitive/behavioral group intervention for weight loss in patients treated with atypical antipsychotics. 1650 43


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