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Comorbidities of Bipolar Disorder: Diabetes

written by: GiangNguyen • edited by: Emma Lloyd • updated: 4/5/2011

Patients with bipolar disorder are vulnerable to developing a host of co-morbidities, including cardiovascular disease and diabetes mellitus. This article focuses on the association between bipolar disorder and diabetes.

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    Bipolar disorder is a serious mental health condition that affects 6-10% of Americans. Bipolar disorder not only increases the risk of suicidal deaths but also imparts significant morbidity.

    According to McIntyre et al. (2005), the medical burden in bipolar disorder is associated with a clustering of risk factors (e.g., obesity, smoking, hypertension unhealthy dietary habits) and inadequate utilization of preventative and primary healthcare. Both cross-sectional and longitudinal studies concluded that the prevalence of diabetes mellitus in patients diagnosed with bipolar disorders is much higher than that in the general population. Regenold et al. (2002) reported that the prevalence of type II diabetes in patients with schizoaffective disorder (50%) and bipolar disorder (26%), were higher than national norms (p<0.05). Since bipolar disorder and diabetes often occurs together, it has been suggested that these diseases may have overlapping pathogenesis.

    Treatment of bipolar disorder might also increase the risk of diabetes. Guo et al (2005) compared the risk for new-onset diabetes associated with atypical versus conventional antipsychotics for patients with bipolar disorders. They found that compared with patients receiving conventional antipsychotics, the risk of diabetes was greatest among patients taking risperidone (hazard ratio: 3.8), olanzapine (3.7, 95% CI 2.5–5.3), and quetiapine (hazard ratio: 2.5). Also, the risk of developing diabetes was associated with weight gain, hypertension and substance abuse. Interestingly, Kessing et al. (2005) reported that the risk of readmission for diabetes was not increased for patients who were previously admitted for depression or bipolar disorder compared to patients with osteoarthritis. Based on these findings, Kessing and colleagues suggested that the risk of diabetes in bipolar disorder patients is not greater than that in patients with other chronic medical illness.

    Based on the existing evidences, McIntyre et al (2005) suggested that the diagnosis and treatment of bipolar disorder patients with diabetes should include care from a multidisciplinary coordinated team. For patients who are close to get diagnosed with diabetes (for instance, those with impaired fasting glucose/impaired glucose tolerance), it is strongly recommended that they modify their diet and exercise to lower the risk of diabetes.

    References

    Mcintyre MD, FRCPC, Roger S., Konarski MSc, PhD, Candidate, Jakub Z., Misener PhD, Virginia L. and Kennedy MD, FRCPC, Sidney H.(2005)'Bipolar Disorder and Diabetes Mellitus: Epidemiology, Etiology, and Treatment Implications',Annals of Clinical Psychiatry,17:2,83 — 93

    Regenold WT, Thapar RK, Marano C, Gavirneni S, and Kondapavuluru PV: Increased prevalence of type 2 diabetes mellitus among psychiatric inpatients with bipolar I affective and schizoaffective disorders independent of psychotropic drug use. J. Affect. Disord. 2002; 70(1):19–26