Can HbA1c be Used to Screen for Glucose Abnormalities Among Adults with Severe Mental Illness?

Abstract

Aim: Prediabetes and type 2 diabetes are highly prevalent among individuals with serious mental illness and increased by antipsychotic medication. Although widely recommended, many obstacles prevent these patients from obtaining a proper screening for dysglycemia. Currently, glycated hemoglobin (HbA1c), fasting glucose, and 2-hour glucose levels from the oral glucose tolerance test are used for screening prediabetes and type 2 diabetes. The objective of this study was to investigate if HbA1c could be used as the only screening test among individuals with serious mental illness.

Methods: Cross sectional study comparing the sensitivity of HbA1c, fasting glucose, and 2-h oral glucose tolerance test to detect dysglycemias in serious mental illness participants referred for metabolic complications.

Results: A total of 84 participants (43 female; aged: 38.5±12.8 years; BMI: 35.0±6.8 kg/m²) was included. Regarding prediabetes, 44, 44 and 76% were identified by HbA1c, fasting glucose, and 2 h- oral glucose tolerance test respectively and for type 2 diabetes, 60, 53 and 66% were identified by HbA1c, fasting glucose and 2 h-oral glucose tolerance test. The overlap between the 3 markers was low (8% of participants for prediabetes and 26% for Type 2 diabetes). Sensitivity of HbA1c were moderate (range 40–62.5%), while its specificity was excellent (92–93%).

Conclusion: The present study indicates a low agreement between HbA1c, fasting glucose and 2-h oral glucose tolerance test. It appears that these markers do not identify the same participants. Thus, HbA1c may not be used alone to detect all glucose abnormalities among individuals with serious mental illness.

Key words

pre-diabetes - diabetes - obesity - OGTT - fasting glucose - screening

• References

• 1 Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis 2006; 3: A42
• 2 Parks J, Svendsen D, Singer P et al. Morbidity and mortality in people with serious mental illness. National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council Alexandria, VA 2006
• 3 Holt RIG, Mitchell AJ. Diabetes mellitus and severe mental illness: mechanisms and clinical implications. Nat Rev Endocrinol 2015; 11: 79-89
• 4 Citrome L. Focus on the clinical ramifications of antipsychotic choice for the risk for developing type 2 diabetes mellitus. Int J Neuropsychopharmacol 2005; 8: 147-151
• 5 Holt RIG, Bushe C, Citrome L. Diabetes and schizophrenia 2005: are we any closer to understanding the link?. J Psychopharmacol 2005; 19: 56-65
• 6 Lamberti JS, Crilly JF, Maharaj K et al. Prevalence of diabetes mellitus among outpatients with severe mental disorders receiving atypical antipsychotic drugs. J Clin Psychiatry 2004; 65: 702-706
• 7 Stubbs B, Vancampfort D, De Hert M et al. The prevalence and predictors of type two diabetes mellitus in people with schizophrenia: a systematic review and comparative meta-analysis. Acta Psychiatr Scand 2015; 132: 144-157
• 8 Bushe C, Holt R. Prevalence of diabetes and impaired glucose tolerance in patients with schizophrenia. Br J Psychiatry Suppl 2004; 47: S67-S71
• 9 Casagrande SS, Anderson CAM, Dalcin A et al. Dietary intake of adults with serious mental illness. Psychiatr Rehabil J 2011; 35: 137-140
• 10 Beebe LH, Smith K. Feasibility of the Walk, Address, Learn and Cue (WALC) Intervention for schizophrenia spectrum disorders. Arch Psychiatr Nurs. 2010; 24: 54-62
• 11 Mitchell AJ, Vancampfort D, De Herdt A et al. Is the prevalence of metabolic syndrome and metabolic abnormalities increased in early schizophrenia? A comparative meta-analysis of first episode, untreated and treated patients. Schizophr Bull 2013; 39: 295-305
• 12 Holt RIG. The prevention of diabetes and cardiovascular disease in people with schizophrenia. Acta Psychiatr Scand 2015; 132: 86-96
• 13 Wani RA, Dar MA, Chandel RK et al. Effects of switching from olanzapine to aripiprazole on the metabolic profiles of patients with schizophrenia and metabolic syndrome: a double-blind, randomized, open-label study. Neuropsychiatr Dis Treat 2015; 11: 685-693
• 14 Bauer LK, Wulsin LR, Guadagno G. Acute psychosis and type 2 diabetes mellitus:should screening guidelines be revised?. Prim Care Companion CNS Disord 2011; 13: 1
• 15 Zeier K, Connell R, Resch W et al. Recommendations for lab monitoring of atypical antipsychotics. Curr Psychiatry 2013; 12: 51
• 16 American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity . Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004; 27: 596-601
• 17 Henderson DC, Vincenzi B, Andrea NV et al. Pathophysiological mechanisms of increased cardiometabolic risk in people with schizophrenia and other severe mental illnesses. Lancet Psychiatry 2015; 2: 452-464
• 18 Dixon L, Weiden P, Delahanty J et al. Prevalence and correlates of diabetes in national schizophrenia samples. Schizophr Bull 2000; 26: 903-912
• 19 Becker T, Hux J. Risk of acute complications of diabetes among people with schizophrenia in Ontario, Canada. Diabetes Care 2011; 34: 398-402
• 20 Mitchell AJ, Delaffon V, Vancampfort D et al. Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices. Psychol Med 2012; 42: 125-147
• 21 Robson D, Gray R. Serious mental illness and physical health problems: a discussion paper. Int J Nurs Stud 2007; 44: 457-466
• 22 Stanton R, Platania-Phung C, Gaskin CJ et al. Screening for Metabolic Syndrome in Mental Health Consumers Using an Electronic Metabolic Monitoring Form. Issues Ment Health Nurs 2016; 37: 239-244
• 23 Canadian Diabetes Association Clinical Practice Guidelines Expert Committee . Goldenberg R, Punthakee Z. Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome. Can J Diabetes 2013; 37 (Suppl. 01) S8-S11
• 24 Manu P, Correll CU, van Winkel R et al. Prediabetes in patients treated with antipsychotic drugs. J Clin Psychiatry 2012; 73: 460-466
• 25 Steylen PM, van der Heijden FM, Hoogendijk WJ et al. Glycosylated hemoglobin as a screening test for hyperglycemia in antipsychotic-treated patients: a follow-up study. Diabetes Metab Syndr Obes Targets Ther 2015; 8: 57-63
• 26 Hanssens L, De Hert M, Van Eyck D et al. Usefulness of glycosylated haemoglobin (HbA1c) to screen for diabetes in patients with schizophrenia. Schizophr Res 2006; 85: 296-297
• 27 Saukkonen T, Cederberg H, Jokelainen J et al. Limited overlap between intermediate hyperglycemia as defined by A1C 5.7–6.4%, impaired fasting glucose, and impaired glucose tolerance. Diabetes Care 2011; 34: 2314-2316
• 28 Li J, Ma H, Na L et al. Increased hemoglobin A1c threshold for prediabetes remarkably improving the agreement between A1c and oral glucose tolerance test criteria in obese population. J Clin Endocrinol Metab 2015; 100: 1997-2005
• 29 Incani M, Sentinelli F, Perra L et al. Glycated hemoglobin for the diagnosis of diabetes and prediabetes: Diagnostic impact on obese and lean subjects, and phenotypic characterization. J Diabetes Investig 2015; 6: 44-50
• 30 Icks A, Haastert B, Gandjour A et al. Cost-effectiveness analysis of different screening procedures for type 2 diabetes: the KORA Survey 2000. Diabetes Care 2004; 27: 2120-2128